Atopic dermatitis (AD, also called eczema) is a chronic skin disorder that affects children and adults. It causes dry, easily irritated, itchy skin. The rash typically starts before age 4, but can start at any age. As an infant, the rash involves the face/head and is more generalized on the body; as kids become older, the rash involves the arms/legs and then tends to involve more specific areas – including behind the knees, behind the elbows, the tops of the hands and feet. The rash may wax and wane but often keeps coming back.
The exact cause is unknown and identifying a specific trigger (food, environmental, etc.) is very difficult and can prove to be very frustrating. We do know that AD is genetic and tends to run in families that have asthma, and allergies in addition to eczema. We also know that individuals with AD have an impaired skin barrier. Our skin barrier has two main functions – to hold in moisture and to protect us from irritants. Thus, the skin of patients with AD becomes dry and is much more easily irritated by things that do not normally bother people (like cold weather/temperature change, environmental pollens, molds, sweat, wool/synthetic fabrics, saliva, chemical sunscreens). Some children may not have any identifiable triggers. Everyone’s triggers are different and triggers tend to change over time. Food is not a common trigger for eczema even in children with food allergies. Typically, when children with documented food allergies avoid that specific food their atopic dermatitis does not improve.
Unfortunately, there is no cure for atopic dermatitis, but it can be kept under control with consistent daily skin care, avoidance of known triggers that cause the eczema to flare, and use of topical and/or oral medications.
Dry skin care consists of a daily bath – lukewarm water, 5-10 minutes with gentle soaps – and within 3-5 minutes of getting out of the bath, applying a thick moisturizing cream or ointment. Typically the thicker the moisturizer, the better the penetration of the moisture and the better the barrier it provides. Maintaining a consistent daily skin care routine helps put water back into the skin, repair the skin barrier, and remove irritants that can trigger eczema. Your doctor will provide you with specific recommendations regarding soaps and moisturizers.
In addition to daily skin care, topical medicines (both topical steroids and other alternatives) help treat active eczema (red, rough, itchy areas of the skin). They are typically applied twice a day until the rash clears and then restarted if the rash recurs. Steroid creams/ointments are very effective and safe when used appropriately. The strength of a steroid depends on the active ingredient not the percentage number noted on the tube. Oral antihistamines (like Benadryl) may also reduce itchiness – they work best if given 30 minutes before bed. Your doctor will talk to you about the appropriate treatment regimen for your child and any potential side effects. Some patients with more severe eczema may require additional treatment options including light therapy and oral medications.
If you avoid irritants/triggers, keep the skin moisturized and minimize scratching, flares of atopic dermatitis will decrease in number and intensity. However, some flares are beyond our control. It is important to use prescribed topical medicines whenever the skin flares to help the skin return to normal quickly.
Atopic dermatitis improves over time. Most children do outgrow the condition, but some typically have dry, sensitive skin as adults.