Atopic Dermatitis

Recognizing Atopic Dermatitis

Atopic dermatitis is a type of eczema. "Atopic" refers to a tendency to develop allergies, although not everyone who has this rash has a problem with allergies. "Dermatitis" just means irritated skin.

Atopic dermatitis is a dry, itchy rash that may cover small or large areas of the body. It can be so itchy that it interferes with sleep, and it can be very difficult not to scratch. In severe cases, the skin may crack and bleed. There may also be small blisters which contain clear fluid. It's common for the rash to have periodic flare-ups followed by periods of improvement.

At first, scratching leads to reddened, raw skin and mild swelling. The skin may "weep" clear fluid, which dries to form a crust. If the rash is not treated, skin may thicken and show prominent, deep lines at skin folds like the inner elbows.

Atopic dermatitis often appears

• on the face
• on the delicate skin of the inner elbows
• on the backs of the knees
• on the hands and feet.

Who Gets It

This rash is most common in people with asthma or allergies, or with a family history of these problems. It often begins during infancy or childhood, although it can appear at any age. In the U.S., it affects about 10% of children and 1% of adults. Almost all cases first occur before age 5, and for many people the rash goes away before they reach adulthood.

Causes

The cause is not known. It probably has a genetic component, since it tends to run in families. It may be a problem with the immune system, with certain cells being over-active or reacting improperly to irritants. There may also be a skin defect which lets irritants enter the skin, causing an immune reaction.

Atopic dermatitis may be triggered by very warm or cold climates, or during the hottest or coldest times of year. It may be exacerbated by certain substances, including soaps and some cosmetics. Stress is another influence; although stress does not cause this skin disorder, it can make it worse.

Home Remedies

For many people, over-the-counter medicines and home remedies will help. Always check with a doctor before using any treatment on babies and children.

Steroids

A mild steroid called hydrocortisone is available at the drugstore. It's sold in 0.5% and 1% creams and ointments and is usually found in the first aid aisle. Applied twice a day, this medicine can help relieve the itch and allow the rash to heal. It's important to follow the package directions, because overuse of steroids can be dangerous.

Antihistamines

Over-the-counter antihistamines may help relieve the itching. They also induce sleepiness, which can help control night-time scratching.

Moisturizers

Heavy moisturizers help protect the skin and relieve the irritating dryness. Petroleum jelly (such as Vaseline) is messy, but it's very effective for helping skin retain moisture. Many doctors also recommend Cetaphil or Eucerin creams.

Tar

Tar preparations are smelly and can stain clothes, but some people find them very helpful. If tar creams and solutions are not available at your drugstore, a pharmacist may be able to make them. Avoid gels, which contain alcohol and can be drying or irritating.

Prevention

Once the rash is under control, simple prevention efforts can help prevent flare-ups.

• Keep skin moist, using lotions, creams, or ointments designed for sensitive skin. Applying cream immediately after bathing helps keep moisture in.

• Avoid fragranced products. Fragrances can cause contact or "allergic" dermatitis, making the rash worse.

• Use gentle soaps or non-soap cleansers.
• Avoid wearing wool next to the skin. Wool can be irritating to [sensitive skin.

• Wear gloves when using household cleaners or solvents.

• Avoid long, hot showers and saunas.

When to Call the Doctor

The itch of eczema can be maddening. If over-the-counter treatments don't help, a doctor can provide stronger medicine.

Be sure to see a physician if:

• The rash is new. A doctor can confirm the diagnosis or identify a different cause.
• The rash worsens or fails to improve.
• The fluid oozing from the rash is white, yellow, green, or foul-smelling; these symptoms suggest a bacterial infection.
• The rash has a red, raised border, which may signal a fungal infection.
• The skin is painful or unbearably itchy.

Prescription Treatments

Prescription treatments for this rash include:

• Steroids. A doctor can prescribe steroids that are stronger than over-the-counter versions.

• Immunomodulators. These creams, including Elidel and Protopic, suppress certain immune system cells. They may help if steroids have failed.

• Antibiotics. If the rash becomes infected, antibiotics may be needed.