Eczema (Atopic Dermatitis)
Definition
Eczema, also known as atopic dermatitis, is a skin condition that usually appears first in infancy and then at intervals in adult life. (also see Health Profile: Eczema)
Description
Eczema (atopic dermatitis) is often seen in association with other atopic conditions, such as hay fever, asthma, or hives, but is generally not triggered by pollen or other airborne irritants. The disease often runs a chronic course. The term "atopic" is derived from the Greek word atopos, which means "away from the place." It describes a family of sensitivities to ordinary substances to which most people have no reaction. Hence, the sensitivity is "out of place". When the disease starts in infancy, it is sometimes called infantile eczema. This is a red, itching, oozing, crusting dermatitis that tends to be localized primarily on the face and scalp, although spots can appear at other sites. In attempts to relieve the intolerable itching, the child rubs his head, cheeks, and other affected areas with a hand, a pillow, or anything within reach. If the disease continues or recurs after infancy, the skin lesions tend to become dry, brownish-gray, scaly, and thickened.
Causes
A person with eczema often has a history of allergic manifestations such as asthma or hay fever, or a family history of asthma, hay fever, or atopic dermatitis. Eczema may be set off by extreme temperatures, stress, sweating, medication, clothing (especially wool or silk), grease, oils, soap and detergents, and environmental allergens. Patients with eczema are also very susceptible to severe infections from certain viruses, for example, the herpes simplex virus that produces fever blisters and sores.
Symptoms
Eczema looks different at different ages and in people of different races. Its appearance ranges from a red, itchy rash to a thickening or discoloration of the skin. From puberty on, it usually appears as dry, itchy patches in the folds of the elbows and knees. The face, neck, and upper trunk may be involved. The skin may become dry and leathery after repeated scratching. It itches intensely and many of the problems seen by doctors are a result of "itch-scratch-itch" syndrome.
Diagnosis
The diagnosis is often made based on the medical history and physical exam alone.
Treatment
There is no cure for eczema, but there are a number of ways to relieve it. Topical steroids may be prescribed to reduce skin inflammation during an eczema flare-up. Topical steroids come in four strengths: mild, moderately potent, potent, and very potent. The strength of the steroid cream your doctor will prescribe depends on several factors, including the severity of the condition. (View list of topical steroids). Oral corticosteroids are sometimes prescribed in very severe cases and usually under the direction of a dermatologist. Oral prednisone and IM triamcinalone (Kenalog) are examples. In addition, cyclosporine A (Neoral) is an oral medical sometimes used in severe cases. Topical immunomodulators are relatively new drugs available for use in treating atopic eczema. They include tacrolimus (Protopic) and pimecrolimus (Elidel). Tacrolimus is an ointment that reduces inflammation by inhibiting the activity of white blood cells called T lymphocytes. It is a non-steroid. Pimecrolimus is a non-steroid cream that works on the same principles as tacrolimus. It is used for managing mild to moderate atopic eczema. Antihistamines, such as hydroxyzine (Atarax, Vistaril) and doxepin (Adapin, Sinequan, Zonalon ), may be prescribed to control itching, and antibiotics may be given if there is sign of bacterial infection. Patients with severe eczema may benefit from phototherapy (light treatment) with ultraviolet A and/or B, with or without topical coal tar.
Self Care
Patients with eczema have hyperirritable skin. Therefore, anything that dries or irritates the skin will be a problem. The aims of therapy are to decrease trigger factors, reduce itching, suppress inflammation, lubricate the skin, and alleviate anxiety. Dermatologists generally recommend the following:
- Avoid rapid changes of temperature and excessive exercise that promotes sweating
- Avoid rough, scratchy, tight clothing and woolens
- Avoid frequent use of soaps, hot water, and other cleansing procedures that tend to remove natural oil from the skin. Recommended soaps include Dove, Eucerin, Aveeno, Basis, Alpha Keri, and Purpose, and recommended cleansers include Cetaphil or Aquanil.
- Bathe once daily
- Washcloths and brushes should not be used while bathing
- After bathing, the skin should be patted dry (not rubbed) and then immediately (before it dries completely) covered with a thin film of moisturizer cream (e.g. Aquaphor, Eucerin, Dermasil, Vaseline).
Questions
How serious is eczema (atopic dermatitis)? What caused the problem? What type of treatment will you be recommending? Will you be prescribing any medication? What are the side effects? Topical Steroids The following is a partial list of topical steroids used to treat eczema. Very potent:Betamethasone dipropionate (Diprolene)Clobetasol 17-Propionate 0.05% (Dermovate)Halobetasolpropionate (Ultravate)Halcinonide 0.1% (Halog)Potent:Amcinonide 0.1% (Cyclocort)Betamethasone dipropionate 0.5 mg (Diprolene, generics)Betamethasone valerate 0.05% (Betaderm, Celestoderm,Prevex)Desoximetasone 0.25% (Desoxi,Topicort)Diflucortolone valerate 0.1% (Nerisone)Fluocinonlone acetonide 0.25% (Derma,Fluoderm,Synalar)Fluocinonide 0.05% (Lidemol,Lidex,Tyderm,Tiamol,Topsyn)Halcinonide (Halog)Mometasone furoate 0.1% (Elocom)Moderately potent:Betamethasone valerate (Betnovate)Betamethasone valerate (Celestoderm)Clobetasone 17-Butyrate 0.05% (Eumovate)Desonide 0.05% (Desocort)Hydrocortisone acetate 1.0% (Cortef, Hyderm)Hydrocortisone valerate 0.2% (Westcort, Hydroval)Prednicarbate 0.1% (Dermatop)Triamcinolone Acetonide 0.1% (Kenalog,Traiderm)Mild:Desonide (Desocort)Hydrocortisone 0.5% (Cortate, Claritin, Cortoderm)Hydrocortisone Acetate 0.5% (Cortef, Hyderm)
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