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Atopic Dermatitis


Atopic dermatitis, also known as eczema, is a skin condition that usually appears first in infancy and then at intervals in adult life. (also see Health Profile: Eczema)

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Atopic dermatitis (eczema) is often seen in association with other atopic conditions, such as hay fever, asthma, or hives, but is generally not triggered by pollen or other airborne irritants. The disease often runs a chronic course.

The term "atopic" is derived from the Greek word atopos, which means "away from the place." It describes a family of sensitivities to ordinary substances to which most people have no reaction. Hence, the sensitivity is "out of place".

When the disease starts in infancy, it is sometimes called infantile eczema. This is a red, itching, oozing, crusting dermatitis that tends to be localized primarily on the face and scalp, although spots can appear at other sites. In attempts to relieve the intolerable itching, the child rubs his head, cheeks, and other affected areas with a hand, a pillow, or anything within reach.

If the disease continues or recurs after infancy, the skin lesions tend to become dry, brownish-gray, scaly, and thickened.

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Causes and Risk Factors

A person with atopic dermatitis often has a history of allergic manifestations such as asthma or hay fever, or a family history of asthma, hay fever, or atopic dermatitis.

Atopic dermatitis may be set off by extreme temperatures, stress, sweating, medication, clothing (especially wool or silk), grease, oils, soap and detergents, and environmental allergens.

Patients with atopic dermatitis are also very susceptible to severe infections from certain viruses, for example, the herpes simplex virus that produces fever blisters and sores.

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Atopic dermatitis looks different at different ages and in people of different races.

Its appearance ranges from a red, itchy rash to a thickening or discoloration of the skin. From puberty on, it usually appears as dry, itchy patches in the folds of the elbows and knees. The face, neck, and upper trunk may be involved. The skin may become dry and leathery after repeated scratching.

It itches intensely and many of the problems seen by doctors are a result of "itch-scratch-itch" syndrome.

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The diagnosis is often made based on the medical history and physical exam alone.

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There is no cure for this disorder but the symptoms can be relieved.

Topical or oral corticosteroids may be prescribed to reduce inflammation. It is important that you use corticosteroids exactly as prescribed since they may have many side effects, including skin atrophy.

Antihistamines may be prescribed to control itching, and antibiotics may be given if there is sign of bacterial infection.

Patients with severe eczema may benefit from phototherapy (light treatment) with ultraviolet A and/or B, with or without topical coal tar.

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Self Care

Patients with atopic dermatitis have hyperirritable skin. Therefore, anything that dries or irritates the skin will be a problem.

The aims of therapy are to decrease trigger factors, reduce itching, suppress inflammation, lubricate the skin, and alleviate anxiety.

Dermatologists generally recommend the following:

  • Avoid rapid changes of temperature and excessive exercise that promotes sweating

  • Avoid rough, scratchy, tight clothing and woolens

  • Avoid frequent use of soaps, hot water, and other cleansing procedures that tend to remove natural oil from the skin. Recommended soaps include Dove, Eucerin, Aveeno, Basis, Alpha Keri, and Purpose, and recommended cleansers include Cetaphil or Aquanil.

  • Bathe once daily

  • Washcloths and brushes should not be used while bathing

  • After bathing, the skin should be patted dry (not rubbed) and then immediately (before it dries completely) covered with a thin film of moisturizer cream (e.g. Aquaphor, Eucerin, Dermasil, Vaseline).

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Questions to Ask Your Doctor

How serious is atopic dermatitis (eczema)?

What caused the problem?

What type of treatment will you be recommending?

Will you be prescribing any medication? What are the side effects?

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