Atopic Dermatitis (Eczema)

What is atopic dermatitis?

Atopic dermatitis (AD), also called eczema, is a hereditary and chronic skin disorder that is most common in infants or very young children, and may last until the child reaches adolescence or adulthood. Eczema causes the skin to itch, turn red, flake, and become tender.

Parents with eczema are more likely to have children with eczema. However, the exact way it passes from parents to children is not known. There is also an association with asthma and hay fever. Of children who have eczema, most will show signs of the condition in the first year of life. Ninety percent of people will develop eczema before their fifth birthday. It is rare for eczema to develop in an adult with no childhood history. Eczema is not contagious.

Different "trigger factors" can make eczema worse. For example, the condition tends to flare up during times of stress, when the temperature is extremely high or low, when the person has a bacterial infection, or when the skin is irritated by fabrics (such as wool) or detergents.

What are the common locations and symptoms of eczema?

The location and 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 doctor for a diagnosis.

How is eczema diagnosed?

Eczema is very common. The American Academy of Dermatology estimates that, worldwide, 10 to 20 percent of children have eczema. 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 or father who has eczema, asthma, or hay fever are more prone to eczema.

  • Personal history of allergies or asthma

  • Blood tests

  • Patch test. This is used to find allergies by placing small amounts of allergy-causing substances on the skin and monitoring the response. 

Treatment for eczema

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

  • Your age, overall health, and medical history

  • Extent of the reaction

  • Your 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 doctor.

  • Take brief baths or showers using lukewarm water.

  • Practice good skin care techniques.

  • Prevent infections.

  • Do not use harsh soaps. Ask your doctor to recommend a brand.

  • Dress in light clothes--sweating can make eczema worse.

  • Use lubricating lotions at least once a day. Ask your doctor to recommend a brand.

  • Avoid scratching the affected area.

  • Minimize stress.

  • Implement lifestyle changes that prevent flare-ups. 

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

  • Antihistamines. These medications may help to decrease the amount of itching. Some examples include diphenhydramine (Benadryl) or hydroxyzine (Atarax). These medications may cause drowsiness, which can help with sleep. This is considered one of the primary benefits of antihistamines as proper sleep is necessary for skin healing. Some new antihistamines are also available that do not cause drowsiness. Consult your doctor for more information.

  • Steroid creams. These topical medications help to decrease the inflammation in the skin, thus decreasing the itching and swelling. Topical steroids are among the most commonly used medications to reduce the signs and symptoms of eczema. Many topical steroids in various strengths are available. Steroids, if overused, are potentially damaging to the skin. Consult your doctor for more information.

  • Systemic corticosteroids. These medications given internally provide a potent reduction in inflammation, which can relieve itching. They are reserved for only severe cases and can come in the form of a pill or liquid, or given as a shot. There are significant side effects associated with the long term use of systemic corticosteroids so they are only used for a limited time. 

  • Oral antibiotics. These medications kill bacteria known to cause infections in the setting of eczema. Scratching the affected skin is a common way to introduce bacteria to the area leading to infection. A sample from the body part thought to be infected may be taken and cultured in a lab to determine what type of antibiotic to use for the most effective treatment. It is important to take the antibiotic exactly as prescribed including the duration. Early discontinuation of antibiotic therapy increases the risk for resistant bacteria to develop. 

  • Oral cyclosporine. This medication has been used for years to treat cases of eczema that do not respond to other therapies. It is used primarily to prevent rejection after organ transplantation. It suppresses the immune system, stopping it from overreacting and thus preventing eczema from flaring. It is available in capsule or liquid form. It has many potential side effects that should be considered carefully. Consult your doctor as needed.

  • Phototherapy. Two types are used to treat eczema including ultraviolet (UV) light therapy and PUVA (chemophototherapy). Light therapy uses UV light of specific wavelengths to target the immune system and prevent exaggerated responses that lead to inflammation. Phototherapy will likely be used in combination with other therapies in select patients. There are risks and benefits of light therapy that should be weighed carefully with your doctor. 

  • Topical immunomodulator. Topical immunomodulators are a new class of drugs for the treatment of eczema. These drugs are applied directly to the skin to alter the immune response.

There may be other appropriate treatment options available that can be discussed with your doctor.