Dermatitis (Eczema)Atopic Dermatitis |
Physician developed and monitored. Original Date of Publication: 01 Sep 2000
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Original Source: http://www.dermatologychannel.net/dermatitis/atopic.shtml | |
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Atopic Dermatitis
Atopic dermatitis, or atopic eczema, is a common skin disorder that affects 10% to 15% of children. It is a common, relapsing disorder that causes rashes and itching, at times intense, and usually improves later in childhood. Many people, however, continue to be affected to some degree throughout their lives. Some studies show that breastfed children have a lower incidence of atopic dermatitis.
Causes
Genetics play an important role in the occurrence of atopic dermatitis, although the exact mechanism is unknown. When both parents have a history of atopic dermatitis, there is an 80% chance that their children will have it. Families with a history of asthma and allergies also experience a higher incidence rate.
Signs and Symptoms
Approximately 50% of those who develop the condition display symptoms before the age of 1, and 80% display symptoms within the first 5 years of life. Atopic skin often is dry and sensitive, and intense itching is a cardinal feature. The constant rubbing and scratching this provokes sets in motion an itch-scratch cycle that is difficult to control. People with this condition have a low threshold for itch, and mild irritants such as wool clothing and most soaps can worsen the symptoms.
Newly affected areas are quite itchy, and the skin is red with weeping or blistering. Scratching can create wounds, and the skin can become thick and dark, with marked folds, over time. In chronic atopic dermatitis, thick, scaly bumps develop where the skin has been rubbed and scratched.
The distribution of atopic dermatitis varies with age:
- Infants present with red, scaly, oozy, crusty cheeks, and the neck, arms, and legs are involved. Symptoms clear in about half of these children by the time they are 2 or 3 years old.
- In older children, the folds on the arms and behind the knees can become dry, thick, scaly, and very itchy. Atopic dermatitis typically becomes less severe as the child matures.
- In young adults, symptoms typically appear on the face, neck, hands, feet, fingers, and toes. Most of the lesions are thickened, leathery, and dull-looking.
Seventy-five percent of the cases greatly improve by the time children reach adolescence, but 25% continue to have difficulties with the condition through adulthood.
Eyelid dermatitis is commonly associated with atopic dermatitis, and the intense itching and vigorous rubbing this provokes can cause deformities on the corneas of the eyes. Because atopic skin is often scaly and cracked, it is susceptible to secondary bacterial and viral infections. The herpes simplex virus can spread over the skin, causing eczema herpeticum, a condition characterized by itchy vesicles (similar in appearance to chickenpox) and large areas of raw or crusted skin. Infection with Staphylococcus bacteria (staph infection) can cause inflammation, irritation, oozing, and crusting.
Various environmental factors (e.g., dust mites, weeds, animal dander, molds) can cause the condition to flare. Foods, too, can make the skin rashes in atopic dermatitis worse, but this seems to happen only in a small number of people. Eggs, milk, peanuts, soy, nuts, fish, and wheat are the foods most commonly associated with worsening symptoms.
Diagnosis
Diagnosis of atopic dermatitis is based on a positive family history, dry skin, prominent hair follicles, and itchy, red, crusted atopic areas. Psoriasis, scabies (infestation with a skin mite), and other types of eczema, such as contact dermatitis, should be ruled out. Early diagnosis allows effective treatment and rapid resolution.
Treatment
Management of atopic dermatitis includes treating the various aspects of this disease. Because atopic skin is often quite dry and irritated, emollients are a mainstay of treatment. Daily baths or showers, followed immediately by the application of moisturizers, helps to restore the protective skin barrier.
Crusted and oozing areas respond to wet, lukewarm water compresses or a weak aluminum acetate solution. Bath oils lubricate dry areas, but care should be taken with young children because oils can make the bathtub slippery. Bubble baths should be avoided because they irritate the skin.
Cigarette smoking should not be allowed in homes where there is a family member suffering from atopic dermatitis, and pets should be kept outdoors as much as possible. Regular dusting of furniture and vacuuming of carpets and drapes are recommended.
Soft cotton clothing is preferable to wool, which can irritate the skin and trigger a flare-up. In summertime, air conditioning helps. In the winter, heated dry air can exacerbate the condition, so moisturizers should be applied frequently.
If dietary causes are suspected, a trial of eliminating certain foods can be attempted. In general, food sensitivities diminish or resolve by age 5.
Corticosteroid creams and ointments often are prescribed for the itch and rash. These formulations are applied to the affected areas only, and weaning the patient off of them periodically helps to minimize their side effects. Given the widespread use of cortisone creams, reports of side effects are surprisingly few, but they include thinning of the skin, stretch marks, telangiectases (broken blood vessels) in the underlying skin, and, sometimes, systemic absorption. Weaker formulations of these creams are used on the face and in skin folds, and stronger preparations are used on thickened skin.
Oral corticosteroids such as prednisone sometimes are used for severe flare-ups.
Topical anti-itch lotions and oral antihistamines also help control itching. Tar solutions that help relieve itching and inflammation can be applied to the skin or added to the bath. In extensive and chronic cases, ultraviolet-light treatments may be administered in the doctor's office.
Preliminary studies with topical tacrolimus ointment have been very encouraging. This medication will become widely available in 2001. Tacrolimus is an immune-suppressing agent used systemically in liver transplant patients. Topical formulations have proven to cause fewer side effects than oral and injectable forms of the medication.
Prevention
Persons with atopic dermatitis can prevent flare-ups by avoiding exacerbating factors such as excessive perspiration and dryness of the skin, irritating fabrics such as wool, irritating soaps and detergents, and, in a small number of children, certain foods.
Supplementation with essential fatty acids, particularly evening primrose oil, can help minimize inflammation in the skin. Both topical and oral aloe vera are also useful.
Dermatitis (Eczema), Atopic Dermatitis reprinted with permission from dermatologychannel.net
© 1998-2008 Healthcommunities.com, Inc. All Rights Reserved.
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