• Eczema

    (Atopic Dermatitis)

    Definition

    Eczema, also known as atopic dermatitis, is a chronic inflammation of the outer layers of the skin. This condition is not contagious.
    Eczema
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    Causes

    The exact cause of eczema is unknown. Factors that may contribute to eczema include:
    • Genetics
    • Environment
    • Allergies to certain fabrics, perfumes in soaps, dust mites (common), or foods
    • Stress, especially if it leads to scratching
    • Frequent washing of affected areas
    • Use of rubber gloves in persons sensitive to latex
    • Scratching or rubbing of skin

    Symptoms

    The symptoms vary from person to person. Scratching and rubbing can cause or worsen some of the symptoms. Symptoms include:
    • Dry, itchy skin
    • Cracks behind the ears or in other skin creases
    • Rashes on the cheeks, arms, and legs
    • Red, scaly skin
    • Thick, leathery skin
    • Small, raised bumps on the skin
    • Crusting, oozing, or cracking of the skin
    • Symptoms that worsen in the winter when inside air is dry due to central heating

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to specialist. A dermatologist focuses on skin disorders. An allergist focuses on allergies.

    Treatment

    The main goals of eczema treatments are to:
    • Heal the skin and keep it healthy
    • Stop scratching or rubbing
    • Avoid skin infection
    • Prevent flare-ups
    • Recognize and avoid triggers, if there are any
    Treatment options may vary. Your doctor may recommend more than one depending on your condition. They include:

    Skin Care

    • Avoid hot or long baths or showers. Keep them less than 15 minutes.
    • Use mild, unscented bar soap or nonsoap cleanser. Use it sparingly.
    • Air-dry or gently pat dry after bathing. Apply gentle moisturizer right after.
    • Treat skin infections right away.

    Medications

    • Prescription creams and ointments containing cortisone, tacrolimus, or pimecrolimus
    • Oral medications, such as prednisone or cyclosporine—For severe cases
    • Antibiotics applied directly to the skin or taken by mouth—Only for treating infections
    • Prescription or over-the-counter antihistamines to help prevent itching

    Phototherapy

    • Treatment with ultraviolet (UV) light by a doctor
    • Photopheresis—For severe cases

    Prevention

    It is difficult to prevent eczema. This is most true when there is a strong family history.
    You may be able to reduce your child's risk of eczema by:
    • Breastfeeding
    • For bottlefed infants, using a certain kind of formula—Ask the doctor if your baby should have 100% whey protein formula
    • Exposing your child to pets at an early age
    • Taking probiotics while pregnant and after giving birth if you are breastfeeding
    Your doctor may have more information regarding steps for reducing the risk of eczema.
    If you already have eczema, there are several things you can do to try to control it:
    • Follow guidelines to limit house dust mites in bedding.
    • Avoid direct contact with wool to the skin.
    • Talk to your doctor about any natural or herbal treatments. Some of these may make eczema worse.
    • Apply a moisturizer to your skin often.
    • Avoid scratching or rubbing.
    • Follow your treatment plan. Improvement may take several weeks or even months after a new medicine is started.
    • Maintain a cool, stable environment. Keep humidity levels the same.
    • Recognize and limit emotional stress.

    RESOURCES

    American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org

    National Eczema Society http://www.eczema.org

    CANADIAN RESOURCES

    Canadian Dermatology Association http://www.dermatology.ca

    Dermatologists.ca http://www.dermatologists.ca

    References

    Atopic dermatitis. American Academy of Dermatology website. Available at: http://www.aad.org/skin-conditions/dermatology-a-to-z/atopic-dermatitis. Accessed March 11, 2013.

    Atopic dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Atopic%5FDermatitis/. Accessed March 11, 2013.

    Barnetson RS, Rogers M. Childhood atopic eczema. BMJ. 2002;324:1376-1379.

    Brehler R, Hildebrand A, Luger T. Recent developments in treatment of atopic eczema. J Am Acad Dermatol. 1997;36:983-994.

    Holscher B, Frye C, Wichmann HE, Heinrich J. Exposure to pets and allergies in children. Pediatr Allergy Immunol. 2002;13:334-341.

    Mohla G, Horvath N, Stevens S. Quality of life improvement in a patient with severe atopic dermatitis treated with photopheresis. J Am Acad Dermatol. 1999;40(5 Pt 1):780-782.

    Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet. 1995;346:1065-1069.

    Skin allergy. American Academy of Allergy, Asthma, and Immunology website. Available at: http://www.aaaai.org/patients/allergic%5Fconditions/eczema.stm. Accessed March 11, 2013.

    Wahn U, Bos JD, Goodfield M, et al. Efficacy and safety of pimecrolimus cream in the long-term management of atopic dermatitis in children. Pediatrics. 2002;110(1 Pt 1):e2.

    7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Langan SM, Flohr C, Williams HC. The role of furry pets in eczema: a systematic review. Arch Dermatol. 2007;143:1570-1577.

    6/4/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Alexander DD, Cabana MD. Partially hydrolyzed 100% whey protein infant formula and reduced risk of atopic dermatitis: a meta-analysis. J Pediatr Gastroenterol Nutr. 2010;50(4):422-430.

    1/4/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Dotterud CK, Storr O, Johnsen R, Oien T. Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial. Br J Dermatol. 2010;163:616-623.

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