Atopic dermatitis, also known as eczema, is a common inflammatory condition characterized by an inflamed rash with itching, scaling, and sometimes blisters. Atopic dermatitis can present anywhere on the body and tends to favor the face, arms, and legs. Itching and irritation of the skin are the most common symptoms, and severity can vary from one person to another. Patients with a history of asthma or allergies may experience more severe symptoms. Repeat scratching or rubbing of the skin can result in oozing, crusting and thickening of the skin. Individuals with severely dry skin may also develop painful cracks or fissures.
Atopic dermatitis (AD) can affect people of all ages and backgrounds. It is thought to be caused by an abnormality of the body’s immune system (often due to over-activity of a specific part of the immune system) and its interaction with the environment. This condition is very common in children and usually presents before the age of five. Although there are various treatment options, atopic dermatitis tends to be chronic and recurring with periodic flares. Patients often have sensitive skin which can be easily aggravated by environmental factors such dry weather, excessive moisture, household cleaning products, harsh soaps, plants & vegetation, etc. Approximately 60% of children may outgrow eczema by early adulthood, although it can persist in to adulthood. Adults with eczema tend to have a more chronic and relapsing course. There are also different subtypes of eczema:
- Asteatotic Dermatitis: Eczema which is often associated with dry skin. Patients may experience small cracks and fissures with inflammation of the skin. Often flares during the winter when the weather is dry and cooler.
- Contact Dermatitis: Inflammation of the skin due to environmental allergens and irritants. Causes may include: perfumes & fragrances, household cleaning products & detergents, cosmetics, jewelry (often nickel), weeds & plants, fabrics, leather, and rubber. Sometimes patch testing may be needed to help identify a specific allergen.
- Dyshidrotic Dermatitis: Eczema which may involve the sweat glands of hands and feet. Patients may experience inflamed skin with small vesicles which can itch severely. This condition may flare with repeat hand washing or excessive moisture.
- Nummular Dermatitis: Common form of eczema which can present as round patches of inflamed itchy skin. Although this condition can present anywhere, it tends to favor the arms and legs, and usually flares during winter time. Nummular dermatitis is commonly mistaken for ringworm due to its round configuration.
Treatment of Atopic Dermatitis
Treatment of atopic dermatitis is aimed at reducing inflammation, irritation, and dryness of the skin. Mild cases may be controlled with over-the-counter hydrocortisone creams, moisturizers, and antihistamines. It’s important to avoid any known triggers or allergens that can irritate the skin. More persistent cases can be controlled with prescription medications including steroid creams & ointments, non-steroidal anti-inflammatory creams, corticosteroid injections or pills, light therapy, and other systemic medications. Steroid creams and ointments are considered the standard of care for the treatment of eczema, although there is the risk of thinning and atrophy of the skin with extended use of strong steroids. High potency corticosteroid creams should not be applied to the face, underarms or genitals where the skin is naturally thin. Lower strength steroid creams may be prescribed for such sensitive areas. In addition to topical corticosteroids, frequent moisturization and avoiding triggers are key factors in controlling atopic dermatitis. It’s also important to avoid scratching or picking at the skin as this can exacerbate your condition and increase the risk of secondary infection. Instead of scratching, cool compresses (towel soaked in cool water) can be used on top of your medications to help soothe and calm the skin.
In more severe cases where prescription creams or ointments may not be enough, oral immunosuppressant medications may be prescribed. These medications work by suppressing the hyperactive immune response that is responsible for causing eczema. Although these medications are effective in controlling severe eczema, patients on these medications will need close monitoring due to potential risks and side effects. Depending on your skin type and the severity of your condition, a dermatologist can determine which treatment options are appropriate for you.