Atopic Dermatitis

Atopic dermatitis (AD), also known as eczema, is a chronic inflammation of the skin that causes extreme itching and dry scaly patches on the scalp, forehead, cheeks, and face. Atopic dermatitis commonly occurs especially in non-Hispanic black children in the first year of life, and symptoms may last into adolescence or adulthood. There are several types of atopic dermatitis, including contact dermatitis, dyshidrotic eczema, hand eczema, neurodermatitis, nummular eczema, and stasis dermatitis. Contact dermatitis – This type of atopic dermatitis is caused by a skin reaction to something that is touched and can be either an allergic reaction (allergic contact dermatitis) to plants, such as poison ivy, or to nickel, makeup, jewelry, or latex gloves. Contact dermatitis can also occur from exposure to certain skin irritants and toxic substances (irritant contact dermatitis), such as diaper rash, acid burn, dry, cracked hands from too much water contact, soaps, or an irritated mouth, battery acid, bleach, and pepper spray. Dyshidrotic eczema –This type of atopic dermatitis occurs when the skin barrier cannot protect the skin, causing very dry skin, itching, skin cracking, and blisters, usually on the hands or feet, and tends to have seasonal flares. Hand eczema – This form of atopic dermatitis can be caused by skin irritants, such as too much exposure to water, chemicals, or solvents, or from an allergic reaction, such as to latex gloves. Neurodermatitis – This form of atopic dermatitis is caused by scratching an intense itching on the skin caused by the body’s nerves. Nummular dermatitis – This type of atopic dermatitis looks different than other dermatitis and is characterized by small coin-like lesions on the skin and is most often caused by chemical irritants, allergic reactions, reactions to medications, or poor blood flow. Stasis dermatitis – This form of atopic dermatitis occurs from swelling in the lower extremities or irritants, such as perfumes, dyes, plants, grass, pet hair, or cleaning products.

There are several alternative names for atopic dermatitis, including atopic eczema, contact dermatitis, dermatitis, dyshidrotic eczema, eczema, hand eczema, neurodermatitis, nummular eczema, and stasis dermatitis.

The cause of atopic dermatitis is unknown, although researchers believe that it may be a genetic condition (inherited) because the skin disorder tends to run in families. Atopic dermatitis may be further caused by a gene variation that prevents the skin from protecting itself, making it more vulnerable to allergens, irritants, and environmental factors. Individuals with atopic dermatitis often also have asthma or allergies, such as hay fever or food allergies, or have family members with allergies. Other factors that appear to increase the risk of developing atopic dermatitis include living in a city with high levels of pollution, being female, of higher social class, being born to a mother of older maternal age, having an immune system disorder, being exposed to tobacco smoke, certain skin products or soaps, very hot or cold temperatures, dry weather, certain fabrics, or detergents.

Symptoms of atopic dermatitis depend on the type and vary by individual and include itching (which can be severe), dry skin, thick, cracked, scaly skin, red or brownish-gray patches on the scalp, face, eyelids, neck, upper chest, arms, wrists, hands, knees, ankles, or feet, and reddened, raw skin from scratching that may become infected. Symptoms of atopic dermatitis may be different in infants and children versus adults. In infants, atopic dermatitis may start when a baby is only 2-to-3 months old, appearing suddenly as an itchy rash on the scalp, face, and cheeks that may ooze fluid. Infants may have trouble sleeping due to their discomfort from the itching or develop skin infections from scratching. In older children, atopic dermatitis often appears as an itchy rash, with scaly patches in the creases of elbows or knees, as well as the neck, wrists, buttocks, legs, and ankles. In adults, atopic dermatitis is rare and may look different from that in infants and children, with an itchy rash that may cover much of the body, especially on the neck, face, and eyes, causing very dry skin, scales, cracking, and skin infections. Atopic dermatitis is characterized by remissions that are followed by flare-ups and may cause additional symptoms of sleep loss due to itching, or depression, or anxiety.

While there is no cure for atopic dermatitis, treatments are focused on decreasing the itching, stopping the skin inflammation and dryness, lifestyle changes, and preventing infection as well as good skin care. Treatments used for atopic dermatitis include antihistamines (to ease itching), steroid creams (to ease skin inflammation), systemic corticosteroids (to ease both itching and inflammation in severe atopic dermatitis; prednisone), oral antibiotics (to stop infections), the immunosuppressant, oral cyclosporine (for atopic dermatitis that doesn’t respond to other treatments), phototherapy (ultraviolet light or PUVA to stop inflammation), the topical immunomodulators known as calcineurin inhibitors (to alter immune response; tacrolimus and pimecolimus ), the immunosuppressant, methotrexate, and barrier restoration creams (to moisturize and repair damaged skin). For severe atopic dermatitis that has not responded to other treatment, a new drug, the injectable biologic (monoclonal antibody), dupilumab (Dupixent) was recently approved for use. Treatment for atopic dermatitis also includes avoiding skin irritants and extreme temperatures, as well as practicing good moisturizing skin care, using non-irritant bath oils, creams, or ointments, in addition to lifestyle changes that help manage the condition and prevent flares, such as trying not to scratch the skin and identifying any possible food allergies that may worsen the condition.

There are several online, local, national, and international support groups for atopic dermatitis, including the following: National Eczema Association - https://nationaleczema.org/get-support/ National Eczema Society - https://eczema.org/information-and-advice/local-eczema-support-groups/

Atopic dermatitis can be a chronic disease. However, atopic dermatitis that begins in an infant or young child usually improves, or even disappears, over time. Nearly 50% of children with atopic dermatitis will also have the condition as an adult, although usually in a milder form.

Complications of atopic dermatitis may include an increased risk of developing asthma and hay fever, chronic itchy, scaly skin, skin infections, extremely dry skin, eye eczema, allergic or irritant hand or skin dermatitis, darkened, thickened skin patches, depression and anxiety, and sleep problems.

If your infant or child’s rash does not improve or looks infected, or if the individual is experiencing discomfort that affects daily activities and sleep, make an appointment with your doctor or dermatologist. If the infant has both a rash and fever, seek immediate medical attention.

While atopic dermatitis may not be able to be prevented, the condition can be managed by avoiding irritant soaps, moisturizing the skin at least twice a day, avoiding triggers that can worsen the condition, such as stress, detergents, dust and pollen, identifying any possible food allergies, avoiding extreme temperatures of hot and cold or long exposure to water in baths and showers, and avoiding sweating and scratching affected skin areas.