ECZEMA (ATOPIC DERMATITIS)

What is atopic dermatitis (eczema)?

Atopic dermatitis or eczema is an inflammation of the skin that happens when your body is exposed to something that you are allergic to. You can be exposed to the offending agent by any means, including inhaling it, ingesting it or contacting your skin.

How does atopic dermatitis (eczema) occur?

Eczema is an inherited type of sensitive, dry skin. A personal history of asthma or hay fever or a family history of eczema makes it more likely that you have eczema. Flare-ups occur when there is contact with irritating substances (for example, soap or chlorine). In 30% of infants with eczema, certain foods can cause the eczema to flare up. If you suspect that a particular food item (for example, cow's milk, eggs, or peanut butter) is causing your flare-ups, the eczema should become itchy within 2 hours of eating the food. If this occurs, avoid ever eating this food and talk to our office about food substitutes.

What are the symptoms of atopic dermatitis (eczema)?

The symptoms of atopic dermatitis or eczema include red, sometimes scaly, dry, extremely itchy rash often starting on the cheeks at 2 to 6 months of age. Most commonly effected areas are on flexor surfaces (creases) of elbows, wrists, and knees in children. If scratched, the rash may become raw and weepy.

How is atopic dermatitis (eczema) diagnosed?

We will ask about allergens that you may have contacted recently. We will look at the entire rash, noting where it is and how it looks in each area (for example, whether it is on one or both hands). However, it may take some detective work to figure out exactly what you are allergic to. Tests for specific allergies may be performed. The best test is the skin scratch test with intradermals. In these tests, tiny amounts of suspected allergens are placed on or under your skin. These allergy tests can identify which allergens are causing your symptoms. In some cases blood tests may be done to look for antibodies to suspected allergens.

How is atopic dermatitis (eczema) treated?

Treatment of atopic dermatitis (eczema) requires multiple strategies:
  • Medications - We will prescribe cream or ointment to stop the itching and other symptoms. You may also need to take pills to help stop the itching. Once the rash resolves, you may use the medication in the future for any itchy spots that may arise.

  • Bathing and hydrating the skin - Hydration of the skin followed by lubricating cream is the main way to prevent flare-ups of eczema. You should have one bath a day for 5-10 minutes in cool to lukewarm water. Water-soaked skin is far less itchy. Eczema is very sensitive to soaps. Never use bubble bath. Be sure to use nondrying soap. Keep shampoo off the eczema.

  • Lubricating cream - People with eczema always have dry skin. After a 5-10 minute bath, the skin is hydrated. Trap in the moisture by patting yourself dry and then by applying an outer layer of lubricating cream to the entire skin surface (while still damp). Apply the cream after applying the medicated cream recommended by the physician. Apply the lubricating cream at least once daily (twice a day or more during the winter). For severe eczema, ointments may be needed temporarily to heal the skin.

  • Itching - At the first sign of any itching, apply cream to the areas that itch, if one was recommended by the physician. Keep your fingernails cut short. Also, wash your hands with water frequently to avoid infections. Also avoid further irritating the area of skin where you have the rash and put cool, moist cloths on the areas of skin with dermatitis.

What can I do to relieve my rash?

Wool fibers and clothes made of other scratchy, rough materials make eczema worse. Cotton clothes should be worn as much as possible. Avoid triggers that cause eczema to flare up, such as: excessive heat, sweating, excessive cold, dry air (use a humidifier), chlorine, harsh chemicals, and soaps.