A common skin condition, atopic dermatitis is frequently described as “the Itch that rashes”. Intensely itchy patches form. These patches can be widespread or limited to a few areas. Scratching often leads to redness, swelling, cracking, “weeping” of clear fluid, crusting, and scaling of the skin. Constant scratching can cause skin damage, infection, and sleep loss.
Ten to 20 percent of children and 1 to 3 percent of adults develop atopic dermatitis, making it the most common type of eczema. For 60 percent or more, atopic dermatitis begins during the first year of life, and at least 80 percent have the condition before age 5. While rare, atopic dermatitis can first appear at puberty or later.
Infantile Eczema
When atopic dermatitis begins during infancy, it often is called infantile eczema. In infants, itchy patches tend to develop on the scalp, forehead, and face, especially on the cheeks. For some children, the condition completely resolves by age two. If the condition does not resolve, the childhood phase of atopic dermatitis begins.
During the childhood phase, itchy patches usually form on the back of the knee and the inside of the elbow. When atopic dermatitis develops in an infant or young child, the child tends to get better with time.
Eczema Later in Life
Atopic dermatitis also can be a lifelong condition. Fortunately, for many it tends to become less severe with age. During the teenage and young adult years, the itchy patches often develop on the elbows and knees. Other common sites for these patches are the hands, feet, ankles, wrists; face, neck, and upper chest. Patches are not limited to these areas; they can appear anywhere on the body, including around the eyes and on the eyelids. In teens and adults, patches of atopic dermatitis are typically dry, may look discolored, and also may be scaly or have thickened skin.
Hand Eczema
Atopic dermatitis increases the risk of developing hand eczema. Some people who see their atopic dermatitis clear during adolescence develop hand eczema as adults. More than 50 percent of those who develop atopic dermatitis continue to experience skin rashes as adults, often in the form of hand eczema.
Hand eczema has many causes. Overexposure to irritant chemical trauma, such as soap and water or other solvents, and physical trauma such as digging in the garden with bare hands or handling large quantities of paper, can cause hand eczema or make pre-existing hand eczema worse. Persons with atopic dermatitis have sensitive skin often making them predisposed to .other skin problems.
Without proper diagnosis and treatment, hand eczema can become chronic (long lasting), interfering with everyday activities and on-the-go job tasks. Hand eczema can be stubborn. It may take months for the patches of red, scaly,. and inflamed skin to heal.. For hand eczema to resolve, patients must· continue using the medications as directed, possibly change their daily hygiene and work habits, keep appointments with their dermatologist, and not get discouraged.
To lessen the risk of developing hand eczema, dermatologists recommend:
- Protect hands against harsh soaps, cleansers, and other chemicals by wearing gloves. If the gloves irritate your skin, see a dermatologist for recommendations.
- Use an automatic dishwasher as much as possible.
- Use lukewarm water and a mild soap when washing the hands and always apply a dermatologist, recommended ointment or cream immediately after washing.
- To keep hands soft and supple, apply the dermatologist-recommended product frequently throughout the day.
- When outdoors in cool weather, wear gloves to prevent dry, chapped skin.
- Protect your skin in the same way you would care for a fine silk scarf.
Questions & Answers About Atopic Dermatitis
Q. Since this condition is associated with allergies, can certain foods be the cause?
A. While foods do not directly cause eczema, several studies suggest that certain food sensitivities are associated with infantile and childhood atopic dermatitis. There is some evidence that avoiding foods to which there is a known. sensitivity may reduce the severity and extent of atopic dermatitis, but the reason for this is difficult to establish. Common foods that can cause problems include milk products, nuts, and shellfish.
Before eliminating foods from a child’s diet, be sure to discuss the plan with a dermatologist. This will help to ensure the child is still receiving proper nutrition.
Q. Are environmental causes important, and should they be eliminated?
A. Many everyday objects can irritate the skin and cause atopic dermatitis to flare. Wool and other fabrics that feel rough to the touch, jewelry, and even some lotions can worsen atopic dermatitis. Learn what irritates the skin and limit contact with these things. For persons with atopic dermatitis who also have hay fever or asthma, controlling the lung disease is necessary to clear up the skin disease. Staying indoors during high pollen times and avoiding air pollution can minimize both lung and skin problems.
Q. Are skin tests such as those given to diagnose hay fever or asthma effective in finding the cause of atopic dermatitis?
A. Skin tests and blood tests can sometimes help to identify a food allergy, asthma, and hay fever. Data has not yet shown how these tests can help to identify the cause of atopic dermatitis
Q. Are “shots” such as those given for hay fever and other allergies useful?
A. Not necessarily. Allergy shots have not proven reliable for relieving atopic dermatitis. They may even make the skin condition worse in some patients. However, if the shots help the lung allergies, the skin may get better. Consult a dermatologist before considering allergy shots.
Q. What should be done to treat this condition?
A. See a dermatologist. A dermatologist is a physician who specializes in treating the medical, surgical and cosmetic conditions of the skin, hair and nails. Other skin conditions can resemble atopic dermatitis. Without an accurate diagnosis, treatment can be ineffective. If the diagnosis is atopic dermatitis, a dermatologist can prescribe an appropriate treatment plan. Medical research continues to show that the most effective treatment plan involves treating the skin and making lifestyle changes.
Treating the skin may involve applying a corticosteroid or an immune-modifying medication, which can help reduce the inflammation and itch. Sometimes other medication such as an antihistamine can be beneficial. If the patient has an infection, which is common in patients with atopic dermatitis, an antibiotic will be prescribed. A dermatologist also may recommend ultraviolet (UV) light therapy or another treatment.
Lifestyle changes include frequently applying an appropriate moisturizer, avoiding certain clothing, and using eczema-friendly bathing techniques. A dermatologist can offer many other tips that can help.
If a patient has atopic dermatitis and also hay fever or asthma, a dermatologist can refer the patient to an allergist for testing. Identifying allergens or environmental factors can be beneficial. Sometimes eliminating allergens brings great relief when combined with appropriate treatment and lifestyle changes.