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    Atopic dermatitis

    Infantile eczema; Dermatitis - atopic; Eczema

    Atopic dermatitis is along-term(chronic)skin disorder that involves scaly and itchy rashes.

    Other forms of eczema include:

    • Contact dermatitis
    • Dyshidrotic eczema
    • Nummular eczema
    • Seborrheic dermatitis

    Causes

    Atopicdermatitis is due to a skinreaction (similar to an allergy) in the skin. The reaction leads to ongoing swelling and redness. People with atopic dermititis may be more sensitive because their skin lacks certain proteins.

    Atopic dermatitisis most common in infants. It may start as early as age 2 to 6 months. Many people outgrow it by early adulthood.

    People withatopic dermatitisoften have asthma or seasonal allergies.There is often a family history of allergiessuch as asthma, hay fever, or eczema. People with atopic dermatitis oftentest positive toallergy skin tests.However, atopic dermatitis is not caused by allergies.

    The following can makeatopic dermatitissymptoms worse:

    • Allergies to pollen, mold, dust mites, or animals
    • Cold and dry air in the winter
    • Colds or the flu
    • Contact with irritants and chemicals
    • Contact with rough materials, such as wool
    • Dry skin
    • Emotional stress
    • Drying out of the skin fromtaking too manybaths or showers and swimming too often
    • Getting too hot or too cold, as well as sudden changes of temperature
    • Perfumes or dyes added to skin lotions or soaps

    Symptoms

    Skin changes may include:

    • Blisters with oozing and crusting
    • Dry skin all over the body or areas of bumpy skin on the back of the arms and front of the thighs
    • Ear discharge or bleeding
    • Raw areas of the skin from scratching
    • Skin coloring changes, such asmore or less color than the normal skin tone
    • Skin redness or inflammation around the blisters
    • Thickened or leather-like areas (called lichenification), which can occur after long-term irritation and scratching

    The type and locationof the rash can depend on the age of the patient:

    • In children younger than age 2, skin lesions begin on the face, scalp, hands, and feet. The rash isoften itchy and bubble, ooze, or form crusts.
    • In older children and adults, the rash is more oftenseen on the inside of the knees and elbow. It can also appear on the neck, hands, and feet.
    • Rashes may occur anywhere on the body during a bad outbreak.

    Intense itching is common.Itching may start even before the rash appears. Atopic dermatitis is often called the "itch that rashes" because the itching starts, and then the skin rashfollows as a result ofscratching.

    Exams and Tests

    The health care provider will give you an exam and look at your skin. A physical exam will be done. You may need askinbiopsy to confirm the diagnosis or rule out other causes of dry, itchy skin.

    Diagnosis is based on the:

    • How the skin looks
    • Personal and family history

    Allergy skin testing may be helpful for people with:

    • Hard-to-treat atopic dermatitis
    • Other allergy symptoms
    • Skin rashes that form only on certain areas of the bodyafter exposureto a specific chemical

    Treatment

    SKIN CARE AT HOME

    Daily skin care make cut down on theneed for medicines.

    Avoid scratching the rash or skin:

    • Use a moisturizer, topical steroid cream, or other medicine your doctor prescribes.
    • Takeantihistamine medicines by mouthto reduce severe itching.
    • Keep fingernails cut short.Wearlight gloves during sleep if nighttime scratching is a problem.

    Keep the skin moist (called lubricating or moisturizing the skin). Use ointments (such as petroleum jelly), creams, or lotions 2 - 3 times a day. Choose skin products that arefree of alcohol, scents, dyes,and other chemicals. A humidifier to keep home air moistwill also help.

    Avoidthings that makeyour symptoms worse, such as:

    • Foodsthat may cause an allergic reaction such as eggs in a very young child (always talk to your doctor first)
    • Irritants such as wool and lanolin
    • Strong soaps or detergents, as well as chemicals and solvents
    • Sudden changes in body temperature and stress, which may cause sweating
    • Triggers that cause allergy symptoms

    When washing or bathing:

    • Expose your skin to water for as short a time as possible. Short, cooler baths are better then long, hot baths.
    • Use gentle body washes and cleansers instead of regular soaps.
    • Do not scrub or dry the skin too hard or for too long.
    • Apply lubricating creams, lotions, or ointmentto the skin after bathing while it is damp. This will help trap moisture in the skin.

    MEDICATIONS

    At this time, allergy shots are not used to treat atopic dermatitis. 

    Antihistamines taken by mouth may help with itching orallergies. You can often buy these medicines without a prescription.

    Most causes of atopicdermatitis are treated with medicines placed directly on the skin or scalp (called topical medicines):

    • You will probably be prescribed a mild cortisone (or steroid) cream or ointment at first. You may need a stronger medicine if this doesn't work.
    • Medicines called topical immunomodulators (TIMs) may be prescribed for anyone over 2 years old. TIMs include tacrolimus (protopic) and pimecrolimus (Elidel). Ask your doctor about concerns over a possible cancer risk with the use of these medicines.
    • Creams or ointments that contain coal tar or anthralin may be used for thickened areas.
    • Barrier repair creams containing ceramides may be used.

    Wet-wrap treatment with topical corticosteroids may help control the condition but may lead to an infection.

    Othertreatments that may be used include:

    • Antibiotic creams or pills if the skin is infected
    • Drugs that suppress the immune system, such as cyclosporine, methotrexate, or mycophenolate mofetil
    • Phototherapy, a medical treatment in which your skin is carefully exposed to ultraviolet (UV) light
    • Short-term use of systemic steroids

    Outlook (Prognosis)

    Atopic dermatitis is a long-term condition. Youcan control it with treatment, by avoiding irritants, and by keeping the skin well-moisturized.

    In children,the conditionoften starts to go awayaround age 5 - 6, but flare-ups will often occur. In adults, the problem is generally a long-term orreturning condition.

    Atopic dermatitis may be harder to control if it:

    • Begins at an early age
    • Involves a large amount of the body
    • Occurs along with allergic rhinitis and asthma
    • Occurs in someone with a family history of eczema

    Possible Complications

    • Infections of the skin caused by bacteria, fungi, or viruses
    • Permanent scars
    • Side effects from long-termuse of medicines to control eczema

    When to Contact a Medical Professional

    Call your health care provider if:

    • Atopic dermatitisdoes not get better with home care
    • Symptomsget worseor treatment does not work
    • You have signs of infection (such as fever, redness, or pain)

    Prevention

    Children who are breast-fed until age 4 monthsare less likely to get atopic dermatitis.

    If a child is not breast-fed, using a formula that contains processed cow milk protein (called partially hydrolyzed formula) may cut down onthe chances of developing atopic dermatitis.

    References

    Atopic Dearmatitis, Eczema, and Noninfectious Immunodeficiency Disorders. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 5.

    Greer FR, Sicherer SH, Burks, W and the Committee on Nutrition and Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: The role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121:183-191.

    Lewis-Jones S, Mugglestone MA; Guideline Development Group. Management of atopic eczema in children aged up to 12 years: summary of NICE guidance. BMJ. 2007;335:1263-1264.

    Ascroft DM, Chen LC, Garside R, Stein K, Williams HC. Topical pimecrolimus for eczema. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005500.

    Bath-Hextall FJ, Delamere FM, Williams HC. Dietary exclusions for established atopic eczema. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD005203.

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      A Closer Look

      Self Care

      Tests for Atopic dermatitis

        Review Date: 11/20/2012

        Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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