What is Atopic Dermatitis – Eczema?

Atopic dermatitis (eczema) is a condition that makes the skin look red in some areas and itchy. It is common in children, but can occur in adults at any age.

Atopic dermatitis is long lasting (chronic skin condition) and tends to flare periodically and then clear up. It may be accompanied by asthma or hay fever (Atopic syndrome).

No permanent cure has been found for atopic dermatitis, but certain treatments can prevent new outbreaks while some self-care measures help relieve itching.

For example, it helps to avoid harsh soaps and other irritants, apply medicated creams or ointments, and moisturise your skin regularly.

You should be examined by a dermatologist if the symptoms of atopic dermatitis affect the quality of your life and do not allow you to go about your daily activities or to sleep normally.

Symptoms

Atopic dermatitis (eczema) has signs and symptoms that vary widely from person to person and include:

  • Itching, which may be severe, especially at night
  • Red, brown, and grey patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and in infants, the face and scalp
  • Rash, which may leak fluid and crust over with intense scratching
  • Thickened, cracked skin, and scaly skin
  • Sensitive, swollen skin from scratching

Atopic dermatitis most often begins before age 5 and may persist into adolescence and adulthood. For some people, it flares periodically and then clears up for a time, even for several years.

Factors aggravating Atopic Dermatitis

Most people with atopic dermatitis have Staphylococcus aureus bacteria on their skin. Bacteria multiply quickly when the skin is wounded or injured in the presence of fluid from inflammation and scratching. This can subsequently aggravate the symptoms, especially in young children.

Factors that can aggravate the signs and symptoms of atopic dermatitis:

  • Dry skin, which may be the result of long, hot baths or showers
  • Scratching, which causes further skin damage
  • Bacterial and viral infections
  • Temperature and humidity (seasonal) changes
  • Various chemicals, such as cleaning agents, detergents and soaps
  • Clothes, blankets and carpets made of wool
  • Dust and pollen
  • Atmospheric pollution
  • Cigarette smoke
  • Stress
  • Sweat
  • In children and infants: peanuts, soy, fish, eggs, milk, and wheat (coexisting food allergies)

Treatments and Medicines for Atopic Dermatitis

Atopic dermatitis can be persistent and treatment-resistant. You may need to try various treatments over months or years to control it. And even if you respond to treatment, the symptoms may return.

It is important to recognise the condition early so that to start treatment. If no improvement is observed with regular moisturising and other self-care steps, your doctor may suggest the following treatments and medications:

Medications

  • Creams that control itching and inflammation. Your dermatologist may prescribe a corticosteroid cream or ointment.
  • Creams that help repair the skin. Medicines called calcineurin inhibitors influence the immune system. This is a safe and effective treatment, particularly as a maintenance therapy.
  • Medications to fight infection. You may have to take if you have a bacterial skin infection or an open sore or cracks on your skin that are caused by itching.
  • Oral drugs that control itching. If itching is severe, an antihistamine can help.
  • Oral or intravenous medicines that control inflammation. For more-severe cases, your doctor may prescribe oral or intravenous corticosteroids. After discontinuation of corticosteroids, you should continue hydrating your skin and using other self-care measures to avoid any possible flares.

Therapies

Light Therapy. The simplest form of light therapy (phototherapy) involves exposing the skin to controlled amounts of natural sunlight. Other forms of phototherapy use artificial ultraviolet A (UVA) and narrow band UVB either alone or in combination with medications.

  • Topical or systemic corticosteroids
  • Calcineurin antagonists (ELIDEL – PROTOPIC)
  • Systemic ciclosporin (in severe cases after failure of other systemic treatments)
  • Topical or systemic antibiotics, in case of Staphylococcus of Streptococcus infections.
  • Topical emollient creams. They are the cornerstone of treatment, and frequent use on a daily basis reduces both the number and the severity of flares.
  • Treatment for stress. Counselling can help children and young adults who feel embarrassed or are frustrated by their skin condition.
  • Relaxation, behaviour modification and biofeedback.These approaches may help people with itching and their habit of scratching.