Atopic dermatitis (eczema)

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Atopic dermatitis (eczema) is a condition that makes your skin red and itchy. It’s common in children but can occur at any age. Atopic dermatitis is long lasting (chronic) and tends to flare periodically and then subside. It may be accompanied by asthma or hay fever.

Symptoms

Atopic dermatitis (eczema) signs and symptoms vary widely from person to person and include:

  • Itching, which may be severe, especially at night
  • Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and, in infants, the face and scalp
  • Small, raised bumps, which may leak fluid and crust over when scratched
  • Thickened, cracked, dry, scaly skin
  • Raw, sensitive, swollen skin from scratching

Factors that worsen atopic dermatitis

  • Dry skin, which can result from long, hot baths or showers
  • Scratching, which causes further skin damage
  • Bacteria and viruses
  • Stress
  • Sweat
  • Changes in heat and humidity
  • Solvents, cleaners, soaps and detergents
  • Wool in clothing, blankets and carpets
  • Dust and pollen
  • Tobacco smoke and air pollution
  • Eggs, milk, peanuts, soybeans, fish and wheat, in infants and children

Atopic dermatitis is related to allergies. But eliminating allergens is rarely helpful in clearing the condition. Occasionally, items that trap dust — such as feather pillows, down comforters, mattresses, carpeting and drapes — can worsen the condition.

When to see a doctor

See your doctor if:

  • You’re so uncomfortable that you are losing sleep or are distracted from your daily routines
  • Your skin is painful
  • You suspect your skin is infected (red streaks, pus, yellow scabs)
  • You’ve tried self-care steps without success
  • You think the condition is affecting your eyes or vision

Take your child to the doctor if you notice these signs and symptoms in your child or if you suspect your child has atopic dermatitis.

Seek immediate medical attention for your child if the rash looks infected and he or she has a fever.

Causes

The exact cause of atopic dermatitis (eczema) is unknown. Healthy skin helps retain moisture and protects you from bacteria, irritants and allergens. Eczema is likely related to a mix of factors:

  • Dry, irritable skin, which reduces the skin’s ability to be an effective barrier
  • A gene variation that affects the skin’s barrier function
  • Immune system dysfunction
  • Bacteria, such as Staphylococcus aureus, on the skin that creates a film that blocks sweat glands
  • Environmental conditions

Risk factors

Factors that put people at increased risk of developing the condition include:

  • A personal or family history of eczema, allergies, hay fever or asthma
  • Being a health care worker, which is linked to hand dermatitis

Risk factors for children include:

  • Living in urban areas
  • Being African-American
  • Having parents with a high level of education
  • Attending child care
  • Having attention-deficit/hyperactivity disorder (ADHD)

Complications of atopic dermatitis (eczema) include:

  • Asthma and hayfever.
  • Chronic itchy, scaly skin.
  • Skin infections.
  • Eye problems.
  • Irritant hand dermatitis.
  • Allergic contact dermatitis.
  • Sleep problems. The itch-scratch cycle can cause you to awaken repeatedly and decrease the quality of your sleep.
  • Behavioral problems.

Tests and diagnosis

No lab test is needed to identify atopic dermatitis (eczema). Your doctor will likely make a diagnosis by examining your skin and reviewing your medical history. He or she may also use patch testing or other tests to rule out other skin diseases or identify conditions that accompany your eczema.

Treatments and drugs

Medications

  • Creams that control itching and inflammation. Your doctor may prescribe a corticosteroid cream or ointment.
  • Creams that help repair the skin such as tacrolimus and pimecrolimus.
  • Drugs to fight infection. You may need antibiotics if you have a bacterial skin infection or an open sore or cracked skin caused by scratching.
  • Oral anti-itch drugs.
  • Oral or injected drugs that control inflammation. For more-severe cases, your doctor may prescribe oral corticosteroids — such as prednisone — or an injected corticosteroid.

Therapies

  • Wet dressings.
  • Light therapy.

Infantile eczema

Treatment for infantile eczema includes:

  • Identifying and avoiding skin irritations
  • Avoiding extreme temperatures
  • Lubricating your baby’s skin with bath oils, lotions, creams or ointments

See your baby’s doctor if these measures don’t improve the rash or if the rash looks infected. Your baby may need a prescription medication to control the rash or to treat an infection. Your doctor may recommend an oral antihistamine to help lessen the itch and to cause drowsiness, which may be helpful for nighttime itching and discomfort.

Lifestyle and home remedies

To help reduce itching and soothe inflamed skin, try these self-care measures:

  • Take an oral allergy or anti-itch medication
  • Take a bleach bath
  • Apply an anti-itch cream or calamine lotion to the affected area
  • Moisturize your skin at least twice a day
  • Avoid scratching
  • Apply cool, wet compresses
  • Take a warm bath
  • Choose mild soaps without dyes or perfume
  • Use a humidifier
  • Wear cool, smooth-textured cotton clothing
  • Treat stress and anxiety

 

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