Eczema (Atopic Dermatitis)
“Dermatitis” is inflamed skin. Atopic dermatitis, also known as eczema, is marked by dryness, itching, and a certain type of rash on the body. It is fairly common in both children and adults.
The exact cause is unknown. In many patients, there is a family history of hay fever, asthma, or eczema itself. Rarely, in infants it may be linked to a food or milk sensitivity. This is often hard to pinpoint and manage. In most cases though, no allergic triggers can be found. It is not contagious.
Eczema often starts in infants from the ages of 2 to 6 months. The skin is dry and the rash is quite itchy. This may cause infants to be restless and rub against flat sheets. The rash may involve the face or it may cover a large part of the body. As the child gets older, the rash may become confined to a small area. Early on, it is common for the rash to be on the legs, feet, hands, and arms. It is often seen at the bend of the elbows, knees, on the back of the hands, feet, and on the neck and face. After the rash has been present for some time, the dry itchy skin may become thickened, leathery, and sometimes darker in color. The more it is scratched, the worse the rash becomes, and the thicker the skin gets. Many children with eczema outgrow it before school age. Yet, some children keep having problems as a teen or even as an adult. Late onset in adolescence or adulthood may occur as well.
Many things may affect how severe the condition becomes. All patients with eczema have sensitive and dry skin. Many will find that during the winter months when it is not humid, the dryness and itching becomes worse. On the other hand, some patients are bothered by sweat. These people will find that they have more problems during the summer. Most patients note an increase in itching at times when there are sudden changes in the weather. Other irritants are likely to affect the skin. Use of harsh soaps and detergents and exposure to wool are common problems. Stress may make symptoms worse. Sometimes eczema may become infected by bacteria, yeast, or viruses. This is called a “secondary infection.” Bacterial infections of this type are the most common, and often occur as the result of scratching. The rash gets very red with pus filled pimples and scabs. If this happens, your doctor will prescribe an antibiotic. It will help to control the infection. A more serious problem can be caused by certain viruses. The “cold sore” virus (Herpes simplex) may cause a severe rash. Contact your doctor right away if you suspect this. The virus that causes molluscum, another type of skin problem, also tends to spread quickly in patients with eczema.
What can I expect from treatment?
Sadly, there is no magic cure that always works. The main aim in treatment is to decrease skin outbreaks and relieve itching.
These tips may help:
- Wear loose fitting clothing. Cotton or other light fabrics are best, as they allow the skin to breathe and prevent sweat build-up. Avoid tight elastic waistbands and wool, nylon or other stiff, scratchy fabrics.
- Avoid very hot or very cold water. Avoid showers and bubble baths. Instead take warm baths and use very little soap only when needed. If soap is tolerated, it should be one with surfactant. This type of soap will decrease the drying effect on skin. Use mild, unscented bar soap at the end of the bath, such as Dove® or Cetaphil®. When drying with the towel, pat skin, do not rub.
- Try to bathe only every two to three days. Frequent bathing is known to result in increased water loss through the skin. On the other hand, bathing is a useful way to get water into the skin. Keep bathing time brief (no more than 10 minutes). Do not soak in soapy water. Rinse any soap off well and pat dry.
- Moisturize the skin while still damp after bathing. This helps lock in moisture and prevents dry skin. Do not use lotions since they often contain alcohol and water that evaporate from the skin soon after applied. Thick creams are best, such as Eucerin® or Aquaphor®. Vaseline® petroleum jelly or Crisco® may also be used, especially in very dry weather.
- Keep fingernails short. This prevents damage to the skin from scratching, which also helps prevent infection.
- Harsh laundry soaps can cause dry skin and itching. Use mild laundry soaps free of perfumes, such as All Free® or Cheer Free®. Avoid using fabric softeners.
- Avoid contact with substances you know cause itching. These may include certain perfumes, dust, grass, weeds, wools, and other types of scratchy clothing. In the winter, for instance, cotton underwear or a cotton shirt may be worn under the sweater.
- If you have food allergies, exclude these foods from the diet. To avoid cutting out too many foods in a child’s diet, consult your doctor.
There are a number of medicines that are used. Topical medicines (applied to the skin) are given most of the time. They work well to decrease the itching and control the inflammation. Your doctor will suggest a treatment that is best for the severity and location of the dermatitis. Weaker steroid creams, such as hydrocortisone, can be bought at the drugstore without a prescription. For more severe rashes, stronger steroid creams may be ordered by your doctor. The stronger creams should not be used on the face or in the skin folds. Elidel® and Protopic® are new prescription skin creams used. They target the disease in the skin and are steroid free. They may be safely used on the face.
Certain oral medicines (antihistamines) may help control itching. Some can be bought without an order from your doctor: diphenhydramine (Benadryl®) and loratadine. Some must be prescribed. They mainly help with the itching by causing drowsiness and making it easier to sleep at night.
Some antibiotic pills are useful as well for treating secondary infections. They may also be used for more severe cases.
When the skin is clear of eczema, it is best to stop using the cortisone or non-steroidal ointment. Keep using lubricants to try to prevent new sites of dermatitis. Of course, if itching or a new rash begins, the cortisone or non-steroidals may have to be started again.
Other Tips
- Try to keep the temperature and humidity in the home fairly constant. Use a bedroom air conditioner in the summer. Use a vaporizer or humidifier in the winter. These must be cleaned well and often. Cleaning is needed to prevent molds that may grow and cause allergic symptoms.
- Try to avoid scratching. Eczema is often called “the itch that rashes”. It is known that scratching plays a key role in making the rash worse. Keeping the nails short and well-filed, and using other measures to help to keep the child from itching are helpful.
Call your doctor if:
- Itching prevents sleep.
- The rash becomes worse even with treatment.
- The rash appears to be infected (pus or yellow scabbing).
- A fever of 100° F or 37.7° C occurs.
Resources
National Eczema Association for Science and Education,
4460 Redwood Highway, Suite 16D, San Rafael, California 94903; 415.499.3474 / 800.818.7546; Fax: 415.472.5345
Sends out a quarterly newsletter that offers a lot of good information.
The Inflammatory Skin Disease Institute,
PO Box 1074, Newport News, VA 23601
Other web sites with good information include:
http://www.niams.nih.gov/hi/topics/dermatitis/
http://www.aaaai.org/patients/advocate/2001
/summer/atopicdermatitis.stm
www.foodallergy.org(food recipes)
If you have questions or concerns please call the health care provider who is treating your eczema.
Eczema (Atopic Dermatitis) Treatment Plan
Moisturizing cream
Apply:_______________________ to skin one to two times daily.
Topical medicine
For mild skin irritation, apply___________________________________________ one to two times a day.
For more severe skin irritation, apply______________________________________
_____________________________________twice a day until clear.
Antihistamine
For itching, take _____________________________________________ at bedtime.
You may also give ___________________________________________ in the daytime.
Foods to avoid
_________________________________________________
_________________________________________________
Foods to try
_________________________________________________
_________________________________________________
Vitamins/other supplements
__________________________________________________
Other
__________________________________________________
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 10/14/2008
Copyright © 10/09/2008 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #6787
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