Atopic Dermatitis
What is atopic dermatitis?
Atopic dermatitis is also known as “eczema.” It is a long-term skin problem that causes dry, itchy, irritated skin. It can require daily care. Most people (9 out of 10) develop atopic dermatitis before age 5.
Atopic dermatitis is not contagious. Don’t worry about catching it or giving it to someone.
What causes it?
The cause is not fully known. Researchers believe that many factors are involved:
People who get eczema usually have family members who have eczema, asthma, or hay fever.
There is no cure for Atopic Dermatitis (AD). It is easy to find products that claim to cure eczema in just a few weeks. These claims give people false hope. The truth is AD cannot be cured, but most cases can be controlled with proper treatment.
What are the symptoms?
-
Extremely itchy patches of skin. The skin may not always itch. The itching may come and go.In infants, it tends to form on the scalp and face, especially on the cheeks. Teens and young adults are more likely to see the rash on their hands and feet. Other common sites are ankles, wrists, face, neck, upper chest, the bends of the elbows and behind the knees. It may not always appear in these areas. It can be anywhere on the skin, including around the eyes and on the eyelids.
-
Rash. This often appears after the itchy skin is scratched or rubbed, but not always. A rash can occur even when the skin is not scratched.
-
Skin can swell, crack, “weep” clear fluid, crust, and scale.
-
Rash may bubble up and ooze or be scaly, dry, and red.
-
Without proper treatment, the skin thickens to protect itself from further damage caused by scratching. This thickening of the skin is called “lichenification.”
Treatment
If the diagnosis is “eczema”, your provider will explain what type of eczema you have and prescribe a treatment plan. The goal of the treatment is to:
-
Control itching
-
Reduce skin inflammation (redness)
-
Clear infection (rare)
-
Loosen and remove scaly spots
-
Reduce and prevent new areas of rash
For best results, combine treatment with skin care and prevention. Many parents and patients are looking for that one treatment or thing that delivers relief. It is important to realize that in most cases no one treatment will be enough.
Research shows that the best way to treat eczema is to treat the skin AND prevent flare-ups.
Skin care
-
Bathe in warm, not hot water.
-
Use little or no soap. Use soap only on armpits, groin and feet. Rinse well.
-
Do not take bubble baths.
-
Pat your skin dry. Don’t rub dry.
-
Moisturize right after your bath or shower using a product with no perfume or preservative. Examples are Vanicream, Aveeno and Cetaphil.
Treatments
For treatment of mild to moderate eczema, providers usually start with a steroid medicine that you put on the skin. This may be in the form of ointment, lotion, cream, or foam. The strength may vary.
Providers try to use the mildest form possible to reduce potential side effects. They might use a higher-strength steroid for a short time to treat sudden or severe symptoms. Then later they use milder strengths of the drug.
Prevention (Stop doing things that irritate the skin.)
-
Stay out of extreme heat or cold.
-
During winter months use a humidifier.
-
Know that pet hair and dander and dust can cause it to get worse.
-
Learn stress management techniques.
-
Wear loose-fitting cotton clothing that does not bind or rub the skin. Don’t wear scratchy fabrics.
-
Use products that have no fragrance or preservatives.
Other Treatment Options
Steroid creams and lotions are the main way to treat eczema. However, there are also two steroid-free medicines that treat eczema. They are pimecrolimus (Elidel) and tacrolimus (Protopic). These two drugs treat mild to severe eczema. They don’t have the side effects that steroids often have.
The information that comes with these medicines contains warnings that may frighten you. The American Academy of Dermatology believes these warnings confuse people and cause them needless worry. Studies prove that when used properly, Elidel and Protopic are safe. When applied on the skin, almost none of the medicine gets inside the body.
The medicines that dermatologists prescribe are safe when used right. They reduce the effects of eczema and allow millions of people to live normal lives.
Eczema can be stubborn. If your symptoms last, be sure to tell your provider. Sometimes it helps to change how you use the medicine.
It may help to set aside more time for relaxing activities. Stress triggers flare-ups in many people. It may help to keep a diary to learn what triggers your eczema and then avoid those triggers. Your provider will work with you to make a treatment plan that meets your needs.
“All-natural” treatments are not a substitute for proven medical treatment. A completely safe, all-natural treatment that gets rid of eczema certainly sounds wonderful. If there was such a treatment, your doctor would tell you. The truth is that there are thousands of natural treatments. This suggests that we do not have a natural treatment that works very well.
Non-medical treatments that may help
For many patients, adding these non-medical actions to a treatment plan helps relieve the itch and redness of eczema:
Cool Compress
What it is: A cool compress is a cloth (thin layer of cotton such as piece of T-shirt material or an old sheet) dipped in cool water
How to use it: Wring it out and then put it directly on the skin that itches. At first the itching or pain may feel worse. However, this goes away soon. Leave on for 15-20 minutes. As the water evaporates, it gives a cooling, soothing effect on the skin. Plus it adds moisture. It is very important to moisturize right away after using a compress.
What it does: Helps relieve the redness and itching.
Emollients and Moisturizers
What it is: The word “emollient” means “to soften.” Emollients can leave skin feeling softer. The word “moisturizer” means “to add moisture.”
What they do: In truth, a moisturizer cannot add moisture to the skin. It traps moisture in the skin, which helps prevent water loss. Both emollients and moisturizers can reduce dryness and scaling, which leaves the skin feeling more comfortable.
Most patients with eczema, except for those with seborrheic dermatitis, benefit from frequent use of these products. Research shows that regularly putting a moisturizer on your skin can:
-
Reduce dry skin.
-
Help your skin protect itself. Moisturizer forms a protective layer on the skin.
-
Make steroid skin products more effective. This may reduce the need for long-term use.
-
Reduce skin irritation.
-
Improve the skin’s appearance.
How to use: Most moisturizers are put directly on the skin, but some are added to a bath. When you put a moisturizer on your skin, be sure to put it on right away after bathing. If your skin is still damp, the moisturizer can “lock in” the moisture from the bath or shower.
Moisturizers come in different forms. Ointments lock in moisture best. Creams come in second. They are used for dry skin or mild to moderate eczema. Lotions, which are mostly water, do not lock in moisture as well as other forms. However, some newer lotions are excellent moisturizers. If you prefer a lotion, ask your dermatologist to recommend one.
Many emollients and moisturizers contain preservatives and fragrances that can irritate your skin. Even products labeled “unscented” can irritate the skin because “unscented” means the fragrance is masked. It does not mean the product does not have a fragrance. When a product does not contain a fragrance, it says “fragrance free.”
Your provider can suggest products for your needs. If your skin stings, burns, itches, or feels drier after using an emollient or moisturizer, stop using it. These symptoms mean that the product irritates your skin.
Excellent internet resources:
www.aad.org
American Academy of Dermatology
www.skincarephysicians.com
Sponsored by the American Academy of Dermatology