Atopic dermatitis is a term used to describe a skin condition in which one develops itchy dry skin that can become
red, scaly, crusty or oozing, especially when repeatedly scratched.     

Atopic dermatitis is sometimes called eczema, however this is technically not correct.  Eczema actually refers to many
different types of inflammatory skin condition such as atopic dermatitis, contact dermatitis, nummular eczema, and
seborrheic dermatitis -- so atopic dermatitis is a type of eczema.

Who gets atopic dermatitis?
Atopic dermatitis can affect children and adults, but is much more common in children than adults.   Overall, 10-15%
of all children will suffer from this skin condition.   90% of children with atopic dermatitis will have symptoms before
the age of 5.   About 60% of affected children will still have the condition as adults, although it is typically less severe
at that time.     The condition is less likely to go away if the child has a history of hay fever, asthma, or if there is a
family history of atopic dermatitis.    It is rare for atopic dermatitis to start after age 30.     

What causes atopic dermatitis?
The exact cause is not known.    Most likely it is due to a combination of environmental exposures and hereditary
factors.   About half of children with severe atopic dermatitis end up developing hay fever or asthma by the time they
reach their teens which suggest allergies is a factor.  Further, the majority of people with atopic dermatitis (70%) have
a family history of asthma, allergic rhinitis (hay fever, or environmental allergies), or atopic dermatitis.  About half of
children with severe atopic dermatitis end up developing hay fever or asthma by the time they reach their teens.

One thing that is clear is that itching worsens the development of the rash of atopic eczema.    In fact, the condition is
often called “the itch that rashes” because the more one scratches the worse the rash will become.        

What are the symptoms of atopic dermatitis?
Typically, the skin will be dry and itchy.   With scratching, the rash will worsen, resulting in red, scaly patches.   
When more severe, the rash can result in oozing and crusting lesions which can become infected.     Over time, the
skin can become thick or leathery in appearance.  The rash tends to affect different parts of the body depending on
the age of the individual.

  • In infants, the rash typically involves the cheeks.   Sometimes, it may involve the whole body, except for the
    diaper area.
  • In young children (ages 2-12), the most commonly affected area are the folds of the arms, the wrists, the
    ankles and behind the knees.    
  • In teenagers and adults, the rash often occurs on the hands, the folds of the arms or knees, around the eyes,
    and in the groin.

What makes atopic dermatitis worse?
The skin of individuals with atopic dermatitis is much more sensitive than normal skin.    Substances such as wool,
cosmetics, perfumes, and detergents can result in skin irritation and worsening of the rash.  Even plain soap can
exacerbate the condition as it will remove the skin’s protective oil from the skin.
 

A dry environment will result in increased itching and flares of atopic dermatitis.   This is why the condition often
worsens during the winter months.   However summer can be a problem for some people too, because sweating can
irritate the skin and cause more itching.

Environmental allergens such as dust mite, animals, and pollens can make atopic dermatitis worse, and it is thus useful
to get tested for allergies to find out if these could be exacerbating the problem.

A common misconception is that atopic dermatitis is caused by stress.  Stress clearly correlates with increased skin
itching and rashes of atopic dermatitis, but it is not the actual cause of the disease.


Can foods make atopic dermatitis worse?
Yes...sometimes,  more so in infants and young children than adults.    It is estimated that foods may be a trigger in
50% of children’s atopic dermatitis.   Unlike regular food allergies which can result in life threatening reactions, the
food allergy associated with atopic dermatitis only causes worsening of the rash and it is not a life threatening
condition.  The most common foods associated with eczema in children are
eggs, peanuts, milk, fish, soy, and
wheat.      Skin testing is usually preferred over blood testing for the evaluation of food allergies in infants and children
with atopic dermatitis because young children with eczema often have highly elevated allergy (IgE) antibodies in their
system which can cause inaccurate blood test results.

What can I do to help improve my condition?
  • Avoid scratching.   This is very important as the more you scratch, the worse the rash will become, and the
    higher the risk of a skin infection.  Antihistamines such as Benadryl, Atarax, Claritin, Allegra, and Zyrtec help
    minimize itching – discuss with your doctor if it is OK for you to use them.  
  • Put mittens or cotton socks on your baby’s hands to help prevent scratching.   Even better, wet the socks at
    night to keep the skin moisturized.
  • Moisturize the skin.    This cannot be emphasized enough.   Atopic dermatitis will not get better unless the skin
    is well moisturized.   You should apply a moisturizer at least 5-6 times a day.  The thicker the moisturizer the
    better, as it will stay on longer (so use moisturizers that comes in tubs, not bottles).   You may also want to try
    Crisco shortening - it often works wonders.
  • Avoid perfumes, harsh soaps and detergents, and fabric softeners as these will irritate the skin and make
    eczema worse.  
  • Avoid wool; use 100% cotton when possible.
  • Avoid cigarettes
  • Minimize stress
  • See a board certified allergist to help figure out if foods or environmental allergies are triggers for you.    
  • Humidify the house in the winter (unless you are allergic to dust mites, which thrive in a humid environment).

Bathing tips:
Daily bathing with lukewarm water is fine – bathing doesn’t dry the skin, it’s the evaporation of the water off your
skin
after you get out of the bath (or shower) which results in dry skin.   So the key is not how often you bathe, but
what you use while in the bath, and what you do after the bath.
  • Minimize the use of soap.    Definitely avoid scented soap.
  • Avoid abrasive washcloths
  • Adding cup of mineral oil to the bath water can help keep the skin moisturized
  • If the eczema is severe and you get recurrent skin infections, try adding bleach to the bath.   Once or twice a
    week, add about  ¼ to ½ cup of regular household bleach to the bath (it give about the same concentration as
    pool water) - this will help kill the bacteria on the skin which can make eczema worse.   With this, limit the
    bath to 10-15 minutes and keep the water out of the eyes, mouth, and hair.
  • Pat the skin dry with a towel (don’t rub) and apply a thick moisturizer on the skin as quickly as possible to
    trap the moisture in.
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