It is generally agreed that the tendency to atopy is genetically inherited. People with eczematous dermatitis have a variety of abnormal immunologic findings which are probably related to more than one genetic defect. For example, such individuals tend to have elevated IgE antibody (immunoglobulin E) levels and have difficulty in fighting off certain viral, bacterial, and fungal infections.
Like most other noninfectious diseases, atopic skin disease can be triggered by environmental factors.
- One of the hallmarks of atopic dermatitis is excessive skin dryness, which seems to be due a lack of certain skin proteins. Any factor that promotes dryness is likely to exacerbate atopic dermatitis.
- Common triggers of atopic dermatitis include the following:
- Harsh soaps and detergents.
- Low humidity.
- Rough wool clothing.
- Occlusive rubber or plastic gloves.
- Staphylococcal bacteria.
- Repeated wetting and drying of the skin (food handling).
Eczema most commonly causes dry, reddened skin that itches or burns, although the appearance of eczema varies from person to person and varies according to the specific type of eczema. Intense itching is generally the first symptom in most people with eczema. Sometimes, eczema may lead to blisters and oozing lesions, but eczema can also result in dry and scaly skin. Repeated scratching may lead to thickened, crusty skin.
While any region of the body may be affected by eczema, in children and adults, eczema typically occurs on the face, neck, and the insides of the elbows, knees, and ankles. In infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.
Eczema can sometimes occur as a brief reaction that only leads to symptoms for a few hours or days, but in other cases, the symptoms persist over a longer time and are referred to as chronic dermatitis.
Eczema is a general term for many types of skin inflammation (dermatitis). The most common form of eczema is atopic dermatitis (sometimes these two terms are used interchangeably). However, there are many different forms of eczema.
Eczema can affect people of any age, although the condition is most common in infants, and about 85% of those affected have an onset prior to 5 years of age. Eczema will permanently resolve by age 3 in about half of affected infants. In others, the condition tends to recur throughout life.
People with eczema often have a family history of the condition or a family history of other allergic conditions, such as asthma orhay fever. The nature of the link between these conditions is inadequately understood. Up to 20% of children and 1%-2% of adults are believed to have eczema. Eczema is slightly more common in girls than in boys. It occurs in people of all races.
Eczema is not contagious, but since it is believed to be at least partially inherited, it is not uncommon to find members of the same family affected.
Self-Care at Home
Removing whatever is causing the allergic reaction is the easiest and most effective treatment. This may be as simple as changing your laundry detergent or as difficult as moving to a new climate or changing jobs.
Prevent dry skin by taking warm (not hot) showers or baths. Use a mild soap or body cleanser. Prior to drying off, apply an effective emollient to your wet skin. Emollients are substances that inhibit the evaporation of water. Generally, they are available in jars and have a "stiff" consistency. They do not flow and ought to leave a shine with a slightly greasy feel on the skin. Most good emollients contain petroleum jelly although certain solid vegetable shortenings do a more than creditable job.
Avoid wearing tight-fitting, rough, or scratchy clothing.
Avoid scratching the rash. If you can't stop yourself from scratching, cover the area with a dressing. Wear gloves at night to minimize skin damage from scratching.
Anything that causes sweating can irritate the rash. Avoid strenuous exercise during a flare.
An anti-inflammatory topical agent may be necessary to control a flare of atopic dermatitis.
Apply an nonprescription steroid cream (1% hydrocortisone). The cream must be applied as often as possible without skipping days until the rash is gone.
Diphenhydramine (Benadryl) in pill form may be taken for the itching. Caution: This medication may make you too drowsy to drive a car or operate machinery safely.
Clean the area with a hypoallergenic soap as necessary. Apply an emollient over the topical steroid.
Avoid physical and mental stress. Eating right, light activity, and adequate sleep will help you stay healthy, which can help prevent flares.
Do not expect a quick response. Atopic dermatitis is controllable but consistency in application of treatment products is necessary.
Medical Treatment and Medications
Once your health-care provider is sure you have atopic dermatitis, the mainstays of therapy are anti-inflammatory medications and relief from the itching.
Prescription-strength steroid cream and antihistamine medications are the usual treatments.
If your health-care provider determines that you have a secondary bacterial infection complicating your rash, an oral antibiotic may be prescribed.
For severe cases not responding to high-potency steroid cream, alternate treatments may be tried. These include coal tar, PUVA (psoralen + ultraviolet A light), and chemotherapeutic agents.
Allergy shots (immunotherapy) usually do not work in eczema.