Atopic dermatitis (eczema) is a common type of dermatitis, a inflammatory skin disorder that causes itching, red, swelling and irritation. Symptoms can vary from a mild case that rashes disappear quite quickly to a more severe condition for a long time.  The key goal of treatment is to reduce itching which can trigger or worsen other symptoms.

General information

Dermatitis can occur at any time of life. Most children have a substantial improvement in their eczema by their mid-teens but, in some, severe eczema persists into adulthood.

Dermatitis usually starts on the face and then on the hands and feet. Older children tend to be affected in the elbow and knees, neck, wrists, ankles and feet.  The hands and feet tend to be the most commonly affected areas in adults. Atopic dermatitis is not a contagious condition.

Atopic dermatitis tends to develop more often in people with allergies such as  asthma and hay fever and often spread in families.

Causes

Healthy skin acts as a barrier to maintain skin moisture and to protect the body from environmental challenges. Any factor that disrupts the ability of the skin to work as a barrier could lead to the loss of moisture, and cause dry skin and the entry of allergens, irritants and bacteria, which can result in inflammation and infection.

Potential causes of eczema are:

Factors that cause the skin to become dry, which in turn affects the skin’s barrier function

Genetic mutations that affect the skin’s barrier function

Immune system dysfunction causing an unwanted inflammatory response in the skin.

Certain substances or conditions called trigger factors can cause eczema to flare (ie: become worse). These trigger factors can be:

Irritants such as soaps and detergents, wool, skin infections, dry skin, low humidity, heat, sweating or emotional stress.

Allergens such as pollen, dust mites, molds or foods.

Talk to your doctor may be helpful in finding the triggers.

Signs and symptoms

The classic symptoms of eczema are:

Itching.

This is the worst symptom which can be upsetting and mad-driven.  It also makes the child scratch causing further irritation of the skin and possible infections to develop.

Redness caused by extra blood flowing through the blood vessels in the affected area.

A scratchy appearance to the skin, caused by small fluid filled blisters under the skin called “vesicles.”

Weeping when the blisters burst, and the fluid flows on the skin.

Crusts or scabs that form when the fluid dries.

People with eczema often have dry, scaly skin. Dry skin can be a predisposing factor to developing eczema. Pale patches of skin appear because dermatitis can interrupt the production of pigment which controls skin colour. The effect does fade and disappear.

Lichenification – a leathery, thicker skin area in response to scratching.

Treatment Options

Prescription topical medications include corticosteroids (steroids), PDE4 inhibitors, topical calcineurin inhibitors (TCIs) and skin barrier creams. Available through your doctor, these medications are applied to the infected area of the skin to help reduce redness, bumps, dryness and itching.

Corticosteroids, such as hydrocortisone, reduce the inflammation of an allergic reaction.  If applying a very strong corticosteroid as it can cause the skin to become thin.  These creams should not be put on liberally but instead only the thinnest smear should be applied to the rash.  The best time to do this is after a bath, as the skin is more absorbent.  Talk with your doctor before buying ointments.

Pimecrolimus cream (Elidel) is a topical, steroid-free, anti-inflammatory medication used to treat atopic dermatitis. It can be applied to affected skin on the face, head and around the eyes where corticosteroid creams are not recommended.

In severe dermatitis cases, phototherapy or UV treatment reduce itching and inflammatory sensations. This involves controlled exposure to UV-A and/or UV-B for a few minutes, two to three times every week. A course of treatment may continue for several months.