Atopic dermatitis is a recurrent and chronic eczema that may present at any age. Often this is found in individuals with a family history of allergy, eczema, asthma or hay fever. Known as the “itch that rashes” instead of the “rash that itches” this condition may have intense itching preceding the skin rash. Most older patients note a prominent involvement of the skin folds of the arms and legs, eyelids, the nipples, earlobes and behind the ears. However, the eruption is at times extremely wide spread. Scratch marks, scaling, redness and crusting may be seen. The skin is very dry and may be sensitive to chemicals, fragrances, soaps, wool clothing and other additives. In most instances, the disease becomes milder with age. There is no laboratory test that will make this diagnosis.
In addition to the dry skin and itchy, scratched rash, changes may include:
- Dark circles under the eyes
- Areas of decreased skin pigmentation (pityriasis alba)
- Rough, red to flesh colored bumps on the backs of the arms, things, cheeks or buttocks (keratosis pilaris)
- Increased number or prominence of palmar lines
Helpful control measures include:
- Luke warm (not hot) baths or showers followed immediately by a gentle cream to seal in the moisture. Vanicream is tolerated by almost everyone. If tolerated, newer generation moisturizers actuallly replace the depleted skin lipids, which helps to restore the barrier function of skin. These include CeraVe and Cetaphil Restoraderm. Atopiclair is a prescription cream which takes the restoration one step further.
- Total avoidance of fabric softeners, drier sheets and fragrances.
- Decreased amount of clothing detergent in the washing machine.
- Double rinsing may also be helpful.
- Avoidance of anything that “burns” when applied to the skin.
- Wool irritates the skin.
- If it seems that any food worsens the itching, avoid it. The most common offenders are soy, dairy products, legumes, eggs, wheat fish, chocolate and berries. Some acidic foods (tomatoes/citrus) may also flare the eczema.
- Airborne allergens may be important in individual patients. These include animal dander, dust mites, pollens, and molds.
- Maintenance of a cool, stable temperature in the home and keeping the humidity levels up near 40% may be helpful.
It is usually necessary to have the appropriate strength cortisone cream on hand for flares. They must be treated with respect. A stronger cream is used on the body, and a weaker cream is used on the face or the folds of the skin. Generally, do not apply cortisone cream on the same spot of skin for more than 14 consecutive days. It may be necessary to use ultraviolet light (UV) treatments or topical immunomodulator creams such as Protopic or Elidel. These treatments suppress the inflammation in the skin
There is good reason to support “proactive” treatment and well as “reactive” treatment. In other words, after the flared affected area is well from the daily use of cortisone or immunomodulator cream, using the same cream twice a week may prevent recurrence as soon.
Infections of any kind may cause flaring of atopic dermatitis. Sometimes a hidden focus of sinus infection, for example, can render the dermatitis resistent to treatment. Staphylococcus aureus can live on broken skin and in the nostrils, also making the skin rash hard to treat. These may necessitate treatment with an oral antibiotic.
Many patients control the frequent bacterial colonization by taking a “bleach bath” 2 or 3 times weekly. This is done by adding 2 or 3 CAPfuls (top of the bleach bottle) of chlorine bleach to a full tub of water and then soaking in the tub for 10 minutes.
Patients with chronic eczema can have poor self-esteem. They may find it difficult to interact normally with peers. Daily back massages given by a parent or spouse to an affected individual may decrease the symptoms of itching and the feeling of isolation of this disease.