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Atopic dermatitis, also known as eczema, is a chronic skin condition characterized by dry, scaly, and itchy skin. It can occur during childhood and persist throughout a person’s life. The appearance of atopic dermatitis varies depending on skin color, with light-skinned individuals experiencing red rashes, while those with darker skin may develop brown, purple, or gray rashes. It’s important to note that atopic dermatitis is not contagious.
In addition to the physical symptoms, people with atopic dermatitis are at an increased risk of developing food allergies, hay fever, and asthma. The condition tends to flare up periodically, causing irritation. However, by practicing good skincare habits such as regular moisturizing, itchy sensations can be relieved, and new outbreaks can be prevented. Treatment options for atopic dermatitis may involve the use of medicated ointments or creams.
Symptoms
The signs and symptoms of atopic dermatitis (eczema) can arise anywhere on the body and differ greatly from person to person.
They may consist of:
- Dry and cracked skin
- Itching that could be severe
- Skin rash that is puffy and has a color that varies based on the skin tone
- Red, brown, purple, or gray rashes
- Crusting or fluid filled bumps
- Thickened skin
- Darkening of the skin around the eyes
- Raw, sensitive skin from scratching
Atopic dermatitis typically starts before the age of 5 and can persist throughout adolescence and adulthood. In certain cases, it may have flare-ups followed by periods of remission, which can last for several years.
If you or your child experience symptoms of atopic dermatitis, such as discomfort that affects sleep and daily activities, develop a skin infection with new streaks, pus, or yellow scabs, or have persistent symptoms despite self-care attempts, it is crucial to consult a healthcare professional. Additionally, immediate medical attention should be sought if there is a fever accompanied by an infected-looking rash.
Causes
Atopic dermatitis, also known as eczema, can be attributed to two main factors. Firstly, certain individuals may have a gene variation that compromises the skin’s ability to provide adequate protection. This results in a weakened barrier function, making the skin more susceptible to moisture loss and less effective at shielding against bacteria, irritants, allergens, and environmental elements like tobacco smoke. Secondly, another group of people develop atopic dermatitis due to an overabundance of the bacterium Staphylococcus aureus on their skin. This bacterial overgrowth disrupts the balance of beneficial bacteria and further compromises the skin’s barrier function.
In either case, a weakened skin barrier function can trigger an immune system response, leading to inflammation of the skin and the manifestation of other symptoms associated with atopic dermatitis. It is important to note that atopic dermatitis is just one type of dermatitis, alongside conditions such as contact dermatitis and seborrheic dermatitis (commonly known as dandruff). It is essential to understand that dermatitis, including atopic dermatitis, is not contagious.
Risk factors
A significant contributing factor to the development of atopic dermatitis is a history of eczema, allergies, hay fever, or asthma. Additionally, the presence of these conditions among family members further elevates the risk.
Diagnosis
The following procedure will diagnose atopic dermatitis.
- Physical examination: Healthcare providers can identify atopic dermatitis by talking to the patient about their symptoms, assessing at their skin, and reviewing their medical history. To diagnose allergies and rule out other skin conditions, the patient may need further tests. Consult the healthcare provider about possible food allergies if a specific food caused the child’s rash.
- Patch testing: Patch testing on the skin may be recommended by a healthcare provider. In this test, various chemicals are applied in little amounts to the skin before being covered. The healthcare provider examines the skin during subsequent visits to check for indications of a reaction. Using a patch test, healthcare provider can identify the exact allergies that are causing the dermatitis.
Treatment
Starting with routine moisturizing and other self-care routines can help with atopic dermatitis. Medicated lotions that reduce itching and assist in skin restoration may be recommended by the healthcare provider if these do not work. A combination of these and additional treatments is occasionally used.
Atopic dermatitis can last for years. To control it, the patient might need to attempt a number of medicines over the course of months or years. Additionally, even after a successful course of treatment, symptoms could flare up again.
- Medications: The symptoms of atopic dermatitis can be managed with the help of a number of medications and treatments. These consist of:
- Topical steroid creams: To reduce itching and heal the skin, many options are available. Products come in a variety of strengths, including creams, gels, and ointments. Discuss the possibilities and options with the healthcare provider. Whatever the patient use, make sure to follow the directions and use it before moisturizing (often twice daily). Side effects, such as skin thinning, may result from using a corticosteroid product excessively.
For people older than two, creams or ointments with a calcineurin inhibitor can be an acceptable option. Examples include pimecrolimus (Elidel) and tacrolimus (Protopic). Before using moisturizer, apply it as prescribed. Utilizing these products in direct sunlight is not advised.
- Antibacterial: Antibiotic medications may be recommended by a healthcare provider to treat an infection and relieve any symptoms.
- Inflammatory drugs: To assist in managing the symptoms of more severe eczema, the healthcare provider may prescribe medications. There are a number of options, including cyclosporine, methotrexate, prednisone, mycophenolate, and azathioprine. Observe all guidelines. Due to possible adverse effects such excessive blood sugar, glaucoma, decreased growth in children, and slower wound healing, these medications are only used temporarily.
- Other options for severe eczema: Dupilumab (Dupixent) and tralokinumab (Adbry), two injectable biologics (monoclonal antibodies), may be choices for persons with moderate to severe conditions who do not respond well to previous treatments. According to studies, it is both safe and helpful in reducing atopic dermatitis symptoms. Dupilumab is only for those over the age of 6. Adults should use Talokinumab.
- Therapies
- Wet dressings: Applying a corticosteroid ointment and protecting the medicine with a moist gauze wrap followed by a layer of dry gauze is an efficient, intensive treatment for severe eczema. Because it is labor-intensive and requires nursing skill, this procedure is occasionally performed in a hospital for patients with broad lesions. Inquire with healthcare provider about safe home use of this approach.
- Light therapy: This treatment is given to patients who either do not improve after receiving topical medications or quickly flare up again after receiving them. Phototherapy, the most basic type of light therapy, involves exposing the affected area to controlled amounts of ambient sunshine. Other forms include artificial UVA and UVB, either alone or in combination with medications.
Long-term light therapy, despite being helpful, has negative side effects, such as early aging of the skin, hyperpigmentation, and a raised risk of skin cancer. Due to these factors, phototherapy is less frequently administered to young children and is not given to newborns. The benefits and drawbacks of light treatment should be discussed with your healthcare physician.
- Counseling: It can be beneficial to speak with a therapist or other counselor if the patient is humiliated or frustrated by their skin issue. People who scratch habitually might benefit from relaxation techniques, behavior modification, and biofeedback.
- Baby eczema: Treatment for infantile eczema involves several steps. Firstly, it is important to identify and avoid any skin irritants that could trigger the condition. Additionally, extreme temperatures should be avoided to prevent exacerbation of symptoms. Bathing the baby in warm water for a short duration and promptly applying a cream or ointment while the skin is still damp can help alleviate symptoms. If these measures do not improve the rash or if it appears infected, it is crucial to consult a healthcare provider who may prescribe medication to control the rash or address any infection. In some cases, an oral antihistamine may be recommended to reduce itching and induce drowsiness, particularly for nighttime discomfort. However, it is important to note that certain antihistamines with sedative effects may have a negative impact on the academic performance of certain children.
