Atopic dermatitis (AD), or eczema, is a chronic skin disorder characterized by dry itchy skin. The word “dermatitis” means inflammation of the skin. “Atopic” refers to a group of diseases in which there is an inherited tendency to develop a triad of allergic conditions: eczema, asthma and hay fever. In atopic dermatitis, the skin becomes extremely itchy. Scratching leads to redness, swelling, cracking, “weeping” clear fluid, and finally, crusting and scaling. In most cases, there are periods of time when the disease is worse (called exacerbations or flares) followed by periods when the skin improves or clears up entirely (called remissions). It is not infectious and cannot spread from one person to another.
Atopic dermatitis may affect individuals of any age but is more common in children below the age of 5. It is more likely to occur in children with a family history of allergic conditions such as eczema, asthma and hay fever. Although atopic dermatitis commonly resolves by adulthood, in some children, it continues to be a significant problem over time.
Certain environmental factors can trigger atopic dermatitis flares. These include:
- Cold and dry air
- Sudden change in temperature
- Dry skin
- Frequent showers or hand washing
- Emotional stress
- Clothes made from wool or synthetic fibers
- Contact with potential irritants and chemicals such as detergents, soaps, dyes, perfumes cosmetics, dust, sand, cigarette smoke, chlorine, mineral oil and solvents
- Characteristic dry itchy skin leads to scratching that causes redness, swelling, cracking, "weeping" of clear fluid, crusting and scaling of the skin.
- AD is most commonly seen on the face, hands, feet, behind the knees and inside the elbows; however, it may occur anywhere on the body.
- Atopic dermatitis may also lead to skin conditions such as atopic pleat, cheilitis, hyperlinear palms, hyperpigmented eyelids, ichthyosis, keratosis pilaris, lichenification, papules and utricaria.
- The skin of individuals with atopic dermatitis loses moisture easily and becomes dry, thereby reducing its protective ability. Hence affected areas are more prone to infections by bacteria and viruses, including herpes, warts, and molluscum.
General skin care can be practiced at home to reduce the need for medications. These include:
- Avoid long baths/showers with hot water; luke-warm water is preferred.
- Use mild soap or non-soap cleanser.
- Pat the skin dry gently without rubbing.
- After bath/shower, apply creams and ointments to affected skin to seal in moisture; avoid lotions, as lotions contain high alcohol content and thus evaporate quickly from the skin.
- Antihistamines (either sedating or non-sedating) may be given to reduce itching.
- Topical corticosteroid creams and ointments are the most frequently used treatment for AD. Sometimes, over-the-counter preparations are used, but in many cases, prescription-strength agents are recommended. Topical steroids are best used for flares, twice daily for 1-2 weeks, as needed only. Long-term use of topical steroids can lead to thinning of the skin, telangiectasia (blood vessel) formation, and stretch marks.
- Topical immunomodulators comprise a new class of topical medications, for use in patients above 2 years or age. They work by reducing inflammation of the skin. Topical immunomodulators reduce flares and help maintain good moisturization of the skin.
- Antibiotics may be prescribed in the form of topical creams or oral medication if skin is infected.
- Phototherapy involves the use of UV-A or UV-B light to treat affected areas.
- Systemic corticosteroids in the form of oral prednisone may be prescribed in severe cases of AD. If necessary, treatment is usually limited to 3-4 weeks. Long term use of systemic steroids carries potential risks such as increased blood pressure, increased blood sugar, softening of the bones, and upset stomach.
- Immunosuppressive medications, which act by suppression of the immune system, may be prescribed to adults with severe cases of atopic dermatitis.