What causes Atopic Dermatitis?
The exact cause of atopic dermatitis is unknown.
- It is partly genetic. For many, there is a family history of hay fever (allergic rhinitis), asthma or eczema (atopic dermatitis) itself.
- The skin barrier is not normal, and the skin is easily irritated.
- The skin immune system is more sensitive to triggers such as soaps, dust mites, pet dander, certain foods, or infections that normally do not bother those who don’t have atopic dermatitis. Different people may have different triggers.
What does Atopic Dermatitis look like?
- Atopic dermatitis usually starts in infancy from the ages of 2 to 6 months. The skin is dry and the rash is quite itchy, so infants may be restless and rub against the sheets or scratch if they are able. The rash may involve the face or it may cover a large part of the body.
- As the child gets older, the rash may become more localized to certain parts of the body. In early childhood, the rash is commonly on the legs, feet, hands and arms.
- As a person becomes older, the rash may be limited to the bend of the elbows, knees, on the back of the hands, feet, and/or on the neck and face.
- If the rash becomes more chronic (or stays there for a long time), the dry itchy skin may become thickened, leathery, and sometimes darker than surrounding skin. The more the person scratches, the worse the rash is and the thicker the skin gets.
- Many children with atopic dermatitis outgrow the condition before school age; some continue to have problems as an adolescent or into adulthood.
What affects the severity of Atopic Dermatitis?
Many things may affect the severity of the condition.
- During the winter months (when the humidity is very low), the dryness and itchiness may be worse.
- Some are easily irritated by sweat and will find that their eczema is worse during the summer months.
- Sudden changes in temperature may increase itching.
- Irritants such as harsh soaps, detergents, and exposure to wool may worsen eczema.
- Sometimes atopic dermatitis may become infected by bacteria, yeast, or viruses. This is called "secondary infection."
4 pronged
approach to treating atopic dermatitis (or eczema):
The main goals in treating atopic dermatitis are: 1.
Restore moisture to the skin; 2. Control skin inflammation; 3. Relieve
the itching; 4. Treat bacterial infection or colonization.
- Moisturization
- Moisturize often. The thicker the moisturizer, the better. Ointments are better than creams, which are better than lotions.
- Mild cleansers should be used.
- Daily bathing is a useful way to get water into the skin, but bathing should be brief (no more than 10-15 minutes), in lukewarm (not hot) water. Pat dry (don’t rub) the skin. And very importantly, moisturizer should be applied immediately (within minutes) after the bath or shower to trap moisture within the skin.
- If using a topical medication, use the medication first, then the moisturizer.
- Anti-inflammatory medication
- Primarily "topical medications" (medications applied to the skin) will be used decrease itching and control the rash. Your doctor will suggest a treatment that is most appropriate for the severity and location of the rash.
- Steroid ointments or creams. The strength depends on particular steroid, not the number at the end. Steroids are very effective but can cause side effects such as skin thinning or stretch marks. Use these in the manner prescribed only to the rash (not to normal areas of the skin) and for a limited period of time.
- Non-steroidal topical calcineurin inhibitor ointments or creams. These may be used alone or in combination with topical steroids. They do not have the side effects that topical steroids have but have others that should be discussed with your doctor.
- When the area is smooth, stop using the prescribed medicines but continue frequent moisturization to try to prevent new rashes from occurring. Of course, if itching or a new rash begins, the prescribed medications may have to be reintroduced.
- Wet wraps or Unna boots can be used as intensive treatment of eczema flares.
- Anti-itch treatment
- Scratching breaks the skin open and therefore needs to be controlled. Certain oral medications called antihistamines may help to control itching. They help with the itching by causing some drowsiness and allowing the child to sleep at night. However, the best treatment for itching is to control the skin inflammation.
- Antimicrobial treatment
- Bleach baths work to decrease the amount of bacteria on the skin. This helps to decrease the risk of skin infection and help keep eczema under control.
- Oral antibiotics may be useful for controlling infections as well as control eczema flares.
OTHER IMPORTANT FORMS OF TREATMENT
1. Avoid
triggers or irritants. These may include scented soaps and
detergents, certain perfumes, dust, pollens (trees, grass, weeds), and
wool or other “scratchy” clothing. In the winter, for example,
cotton underwear or a cotton shirt may be worn under the sweater. Use
unscented hypo-allergenic laundry detergent products. Avoid fabric softeners.
2. Keep
the temperature and humidity in the home fairly constant.
Use a bedroom air conditioner in the summer and a vaporizer or humidifier
in winter. It is very important that the vaporizer or humidifier
be cleaned well and frequently since molds may grow and cause allergic
symptoms.
3. Try
to avoid scratching. Atopic dermatitis is often called "the
itch that rashes," and it is known that scratching plays a very
important role in making the dermatitis worse. Keeping the nails
short and well-filed, and using other measures to help to keep the child
from itching are helpful.
4. Alternative therapies.
If the standard treatments for eczema do not work, other options such
as light therapy, cyclosporine, methotrexate, and other forms of systemic
therapy may be advised by your doctor.
- There is an important relationship between different allergic diseases:
- atopic dermatitis (eczema)
- asthma
- allergic rhinitis (hay fever)
- food allergy
- 35% of children with moderate-to-severe atopic dermatitis have associated food allergy
- Food allergy may be considered as a possible trigger in very young patients (i.e., infants) with moderate to severe atopic dermatitis that is hard to control even with good treatment.
- Prevention of food allergy and atopic dermatitis in infants and children:
- Breastfeeding for at least 4 months may prevent or delay atopic disease
- If formula is used, we recommend the use of extensively hydrolyzed formulas until 4-6 months of age.
- Partially hydrolyzed formulas may be a more economical way to try to prevent food allergy or eczema but may not work as well as the extensively hydrolyzed formulas.
- We recommend that solid food introduction be delayed until after 4-6 months of age. There is no evidence that delaying introduction of specific foods (milk, egg, peanut, etc) helps to prevent food allergy.