Atopic dermatitis is a term used to describe a skin condition. It causes itchy dry skin that becomes an inflamed red raised rash when scratched. Typically,
the rash will vary in severity, with times when the rash worsens (flares) and other times when it is nearly non existent (remission). Atopic dermatitis almost
always begins in childhood, and often persists through adulthood.
Atopic dermatitis is sometimes called eczema. However, eczema actually refers to many different types of skin condition, one of which is atopic dermatitis.
Who gets atopic dermatitis?
Atopic dermatitis can affect children and adults—but is 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 cause is not known. It may be due to a combination of genetic and environmental factors.
It may be allergic related as the majority (70%) of people with atopic dermatitis has a family history of asthma, allergic rhinitis (hay fever, or environmental
allergies), or atopic dermatitis. About half of children with severe atopic dermatitis will develop hay fever or asthma by the time they reach their teens.
A common misconception is that atopic dermatitis is caused by stress. Studies show that while stress can worsen the rash, it is not the cause of the
One thing that is clear is that itching is worsens the development of the rash of atopic eczema. 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. 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?
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 difficult also, as sweating can also cause increased itching. Stress can have a dramatic affect on atopic dermatitis as well.
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 atopic dermatitis. Even plain soap can exacerbate the condition as it will remove the skin’s protective oil from the
Environmental allergens such as dust mite, animals, and pollens can make atopic dermatitis worse, so it is worth getting tested for these to find out if these
could be exacerbating the problem.
Can foods make atopic dermatitis worse?
Yes...sometimes, more so in infants and young children. It is estimated food may be a trigger in 50% of children’s atopic dermatitis. This is the result of a
response by the immune system to the food. Usually, this is due to an allergy to food. However, unlike regular food allergies, this type of food allergy is
not life threatening—it only causes worsening of the atopic dermatitis. 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 (RAST) for the evaluation of food allergies in infants and children with atopic
dermatitis. This is because young children with eczema often have highly elevated allergy (IgE) antibodies in their system, which appears to cause many false
positive blood test results for foods.
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 Loratadine (Claritin), Cetirizine (Zyrtec), or Benadryl can help reduce the sensation of itching.
- 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).
- 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.
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 which results in dry
skin. The key what is done during, and after the bath.
- Minimize the use of soap. Definitely avoid scented soap.
- Avoid abrasive washcloths
- 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.
- Adding 1½ 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.
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