Eczema (Atopic Dermatitis)
Eczema is a chronic, itchy skin condition that is often associated with the “allergic triad”: eczema, allergic rhinitis (runny nose due to allergies) and asthma. It develops during the first years of life with 95% of cases appearing by 5 years of age. Most children will “outgrow” their eczema but it can also persist into adulthood. If you are developing eczema as an adult, other conditions must be ruled out first and a consultation with a dermatology specialist is important.
Eczema can be acute, subacute or chronic. There are many subtypes of eczema as well. In the acute phase (“flare up”), there are red, inflamed lesions that can have bullae/vesicles. In the subacute phase, patients develop scaly plaques, erosions and crusts. With chronic eczema, skin thickening, scaling and hypo or hyperpigmentation develop. Infants usually present with eczema on their face, scalp, body and back of arms/legs. In children and adults, eczema appears on the inner aspects of the arms and legs but can be generalized.
Although the cause of eczema is unknown, there is usually a family history of similar symptoms. Environmental factors also contribute to the development and exacerbation of eczema.
Key components of eczema include:
- Xerosis- dry skin. Patients have great difficulty retaining moisture in their skin.
- Intervention: A good twice daily skin moisturizing regimen with fragrance free emollients is crucial to prevent eczema flare ups. Avoid long-hot showers which can strip your skin of moisture.
- Environmental sensitivity/allergy- detergents, soaps, heat, chemicals, smoke, and fragrances can all aggravate eczema. Although patients with eczema can have allergies to eggs, cow’s milk and peanuts, food allergy testing is not typically indicated if eczema is the sole symptom.
- Intervention: use only hypoallergenic products for skin, hair, clothes and bedding. Avoid fragrances. A daily preventive oral antihistamine can also help.
- Pruritis- intense itching. Constant scratching can lead to significant distress, disturbed sleep, a disrupted skin barrier and skin thickening.
- Intervention: nighttime medications such as hydroxyzine can help stop the itch-scratch cycle and provide more restful sleep.
Due to the impaired skin barrier, patients with eczema are more prone to various skin infections. These include Staphylococcus aureus (cause impetigo), Herpes Simplex Virus (causing eczema herpeticum), and Coxackie viruses (causing eczema coxsackium). These may require oral and/or topical antiviral or antibiotic treatments.
Eczema therapy is multi-pronged and includes appropriate skin care, emollient use and trigger avoidance. Most cases of eczema can be managed by topical corticosteroids of varying strengths and topical nonsteroidal ointments of varying strengths. Wet wraps and bleach baths are importance adjuncts to therapy. For extensive disease, immunomodulatory drugs and dermatologist evaluation may be necessary. At Doctors Dermatology, we will provide you with a comprehensive dermatology treatment plan for you or your child’s eczema.