Atopic Dermatitis (Eczema)

What is atopic dermatitis?

Atopic dermatitis, also called eczema, is a hereditary and chronic skin disorder that mostly affects infants or very young children, and may last until the child reaches adolescence or adulthood. Eczema causes the skin to itch, turn red, and flake.

Parents with eczema are more likely to have children with eczema. Different triggers can make eczema worse, including environmental irritants, allergies, and stress.

The condition tends to flare up during times of stress, when the temperature is extremely high or low, when the patient has a bacterial infection, or when the skin is irritated by fabrics (wool) or detergents. Of children who have eczema, 65 percent will show signs of eczema in the first year of life and 90 percent will show signs of eczema within the first 5 years.

What are the symptoms of eczema?

The distribution of eczema may change with age. In infants and young children, eczema is usually located on the face, outside of the elbows, and on the knees. In older children and adults, eczema tends to be on the hands and feet, the arms, and on the back of the knees. The following are the most common symptoms of eczema. However, each person may experience symptoms differently. Symptoms may include:

dry, scaly skin
small bumps that open and weep when scratched
redness and swelling of the skin
a thickening of the skin (with chronic eczema)

Excessive rubbing and scratching can tear the skin and result in an infection. The symptoms of eczema may resemble other skin conditions. Always consult your physician for a diagnosis.

How is eczema diagnosed?

Atopic dermatitis is very common. Over 15 million American adults and children have atopic dermatitis. The National Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that at least 20 percent of infants and children experience symptoms of atopic dermatitis. In addition to a complete medical history and physical examination, diagnostic procedures for eczema may include the following:

family history (Children born to a mother who has allergic conditions are more prone to eczema.)
personal history of allergies or asthma
blood tests

Treatment for eczema:

Specific treatment for eczema will be determined by your physician based on:

your (your child's) age, overall health, and medical history
extent of the reaction
your (your child's) tolerance for specific medications, procedures, or therapies
expectations for the course of the reaction
your opinion or preference

There is no cure for eczema. The goals of treatment are to reduce itching and inflammation of the skin, moisturize the skin, and prevent infection.

Management of eczema symptoms:

The following are suggestions for the management of eczema:

Avoid contact with irritants, as determined by your physician.
Take brief baths or showers using lukewarm water.
Practice good skin care techniques.
Do not use harsh soaps. Ask your physician to recommend a brand.
Dress in light clothes - sweating can make eczema worse.
Use lubricating lotions at least once a day. Ask your physician to recommend a brand.
Avoid scratching the affected area.
Minimize stress.

Your physician may also prescribe medications in severe cases. The following medications are most commonly used to treat eczema:

antihistamines
These medications help to decrease the amount of itching. Some examples include diphenhydramine (Benadryl®) or hydroxyzine (Atarax®). These medications may cause drowsiness. Some new antihistamines are also available that do not cause drowsiness. Consult your physician for more information.
steroid creams
These topical medications help to decrease the inflammation in the skin, thus decreasing the itching and swelling. Many topical steroids in various strengths are available. Steroids, if overused, are potentially damaging to the skin. Consult your physician for more information.
oral antibiotics
oral cyclosporine (to suppress the immune system)
phototherapy
topical immunomodulators (TIMs)
Topical immunomodulators are a new class of drugs for the treatment of eczema. These drugs are used topically to alter the immune response.

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