Dermatitis, Atopic

General Illness Information


Common Name:

ECZEMA (Dermatitis, atopic)

Medical Term: Eczema

Description: It is a chronic, itchy inflammation of the upper layers of the skin. May be associated with other allergic disorders, such as asthma or hay fever and may have family members with these conditions.

There are 3 phase: Infantile phase – birth to two years; Childhood phase – two years to puberty;  Adult phase – after puberty.

It is not contagious and is not associated with cancer.

Causes: Unknown. Probably related to genetic factors and immune system dysfunction. People with atopic dermatitis usually have many other allergic disorders. The relationship between dermatitis and these disorders is not clear; it is postulated that these people may have inherited tendencies to produce excessive antibodies in response to a number of stimuli.

There are numerous factors that may make atopic dermatitis worse, and these are emotional stress, changes in temperature and humidity, contact with irritating fabrics (such as wool) and bacterial skin infection. In infants certain foods may aggravate atopic dermatitis.

Prevention: The following measures may help in prevention:

  • Avoid agents that cause irritation (wool, perfumes, fabric softeners, harsh soaps, etc.);
  • Lubricate skin frequently;
  • Minimize sweating;
  • Lukewarm, not hot baths;
  • Decrease stress if possible;
  • Wear cotton and rubber gloves for household tasks;
  • Avoid wearing synthetic fabrics as they trap perspiration and may cause irritation.

Signs & Symptoms

  • Infantile atopic dermatitis – may appear in the first few months after birth and presents with red, oozing, crusted rashes on the face, scalp, diaper area, hands, elbows and knees (on the outer aspect). Often resolves by age 3 or 4- although it often recurs;
  • Childhood phase – itchy rash in the skin creases of joint area such as elbows, knees, neck, face, hands, feet, groin, genitals, anal area. Rash tends to be scaly and may have thickening of the skin with prominent skin markings (lichenification);
  • Beyond puberty – itchy thickened skin in above areas, white depigmentation. Hands may be severely involved;
  • Other associated features are: dry skin, facial erythema (reddish skin), pale skin around the mouth, increased markings in palmer area of the hand, and hypo pigmented areas (white patches).

Risk Factors

  • Hay fever and asthma;
  • Food allergy to eggs, citrus and milk;
  • Family history;
  • Stress. The rash and itching increases during stressful periods;
  • Irritating chemicals e.g.. wool clothing, soaps, detergents;
  • Skin infections;
  • Exposure to tobacco smoke.

Diagnosis & Treatment

General Measures:

Diagnosis is usually made by detailed history and physical findings. There is no diagnostic test for atopic dermatitis. Blood test may show elevated levels of IgE – an immunoglobulin.

General Measures:

  • Reduce stress in your life, if possible;
  • Bathe in cool to warm water with mild cleansing agents;
  • Minimize use of soap (use super fatted soaps);
  • Limit use of soap to the armpits, groin and feet;
  • Wash cloths and brushes should not be used;
  • After rinsing, the skin should be patted dry (not rubbed) and then immediately after, before it dries completely, apply petroleum or lanolin-based ointments;
  • Frequent systemic lubrication with oil baths (add alpha-Keri bath oil) and followed by moisturizers- 1-3 times daily depending on the codition of the skin;
  • Use cool-water soaks for crusting, oozing lesions. These decrease itching and remove crusts;
  • Humidify the house;
  • Wear loose-fitting, cotton clothing (avoid wool and synthetics);
  • Avoid fabric softeners and anti-static laundry products;
  • Avoid excessive contact with water.

Medications:

Mild Acne

  • Topical steroid preparations helps in 90% of patients;
  • In infants and children – use 0.5 to 1% hydrocortisone creams or ointments;
  • In adults, may use stronger preparations (over 1%) in areas other than face and skin folds. Precaution: Long-term use of potent steroid creams and ointments may cause thinning of the skin and some potentially serious side-effects;
  • Oral cortisone drugs (rarely, and for short periods only);
  • Antihistamines or mild tranquilizers- to relieve itching;
  • Antibiotics (sometimes) to fight secondary infections.

Activity:

No restrictions except to keep cool. Avoid prolonged exposure to heat.

Diet:

An allergy diet may be necessary, if food allergy is suspected. There is controversy regarding the role of food allergies and exacerbations of atopic dermatitis. The most common suspicious foods are eggs, milk, wheat and peanuts. Consider elimination diets i.e. avoiding suspected foods for 3 to 4 weeks and then trying it again (food challenge).

Possible Complications:

  • Secondary bacterial infection in the affected areas;
  • Eczema herpeticum- generalized rash with water blisters and pustules due to herpes simplex (cold sore virus) or vaccinia (chicken pox) virus;
  • Cataracts are more common in patients with atopic dermatitis;
  • Increased susceptibility to adverse drug reactions;
  • Fungal infections;
  • Permanent scarring from scratching;
  • Atrophy (thinning) of the skin and striae (stretch marks) -as a result of long-term use of fluorinated steroid creams on the face and skin creases.

Prognosis

Atopic dermatitis is a chronic disease that tends to burn out with age. 90% of patients have spontaneous resolution by puberty. However, some adults may continue to have localized eczema e.g. chronic hand or foot dermatitis and eye-lid dermatitis. Prognosis is excellent with proper attention and treatment.

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