Atopic dermatitis

Definition

Eczema is a chronic skin disorder that involves scaly and itchy rashes. Eczema is also called atopic dermatitis.

Alternative Names

Causes

Eczema is due to a hypersensitivity reaction (similar to an allergy) in the skin, which leads to long-term inflammation. The inflammation causes the skin to become itchy and scaly. Long-term irritation and scratching can cause the skin to thicken and an have a leather-like texture.

Eczema is most common in infants, and at least half of those cases clear by age 3. In adults, it is generally a long-term or recurring condition. Eczema tends to run in families.

People with eczema often have a family history of allergic conditions like asthma, hay fever

The following can make eczema symptoms worse:

• Dry skin
• Exposure to environmental irritants
• Exposure to water
• Stress
• Temperature changes

Symptoms

• Blisters with oozing and crusting
• Dry, leathery skin areas
• Ear discharge or bleeding
• Intense itching
• Rash
  • In children younger than age 2, skin lesions begin on the cheeks, elbows, or knees
  • In adults, the rash is more commonly seen on the inside of the knees and elbows
• Raw areas of the skin from scratching
• Skin coloring changes -- more or less coloring than the normal skin tone (See: Skin bnormally dark or light)
• Skin redness or inflammation around the blisters

Exams and Tests

Diagnosis is primarily based on the appearance of the skin and on personal and family history. The health care provider should examine the lesions to rule out other possible causes. A skin lesion biopsy may be performed, but is not always required to make the diagnosis.

Treatment

Treatment may vary depending on the appearance (stage) of the lesions -- acute "weeping" lesions, dry scaly lesions, or chronic dry, thickened lesions are each treated differently.

Avoid anything that makes the symptoms worse. This may include food allergens and irritants such as wool and lanolin.

Dry skin often makes the condition worse. When washing or bathing, keep water contact as brief as possible and use less soap than usual. After bathing, it is important to trap the moisture in the skin by applying lubricating cream on the skin while it is damp. Temperature changes and stress may cause sweating and aggravate the condition.

Treatment of weeping lesions may include soothing moisturizers, mild soaps, or wet dressings.

Mild anti-itch lotions or topical corticosteroids (low potency) may soothe less severe or healing areas, or dry scaly lesions.

Chronic thickened areas may be treated with ointments or creams that contain tar compounds, powerful anti-inflammatory medicines, and ingredients that lubricate or soften the skin. Systemic corticosteroids may be prescribed to reduce inflammation in some severe cases.

Medicines called topical immunomodulators (TIMs) may be prescribed in some cases. These medications do not contain corticosteroids. TIMs include tacrolimus (Protopic) and pimecrolimus (Elidel).

Outlook (Prognosis)

Eczema is a chronic condition, but it may be controlled with treatment and by avoiding iirritants. In many cases, eczema in younger persons disappears by early adulthood.

Possible Complications

• Bacterial infections of the skin
• Permanent scars

When to Contact a Medical Professional

Call for an appointment with your health care provider if eczema does not respond to moisturizers or avoiding allergens, if symptoms worsen or treatment is ineffective, or if signs of infection (such as fever, redness, pain) occur.

Prevention

Studies have shown that children who are breast-fed are less likely to get eczema. This is also true when the nursing mother has avoided cow's milk in her diet. Other dietary restrictions may include eggs, fish, peanuts, and soy.

Eczema tends to run in families. Control of stress, nervousness, anxiety, and depression can be beneficial in some cases.

Habif TP. Clinical Dermatology. 4th ed. St. Louis, Mo: Mosby; 2004:41.

Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:2458-2460.