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Atopic dermatitis

What is it?

Atopic dermatitis (der-muh-TI-tis) is also called eczema (EGG-zih-muh). Eczema is an itchy, red skin rash. It happens more often in babies and young children, but people can get eczema at any age. Although there is no cure for eczema, it can be treated. Treatment includes staying away from things that cause your eczema flare-ups and using moisturizers and special medicines. Eczema cannot be spread to others. It can be a short or long term problem and may last days, months, or years. Eczema that starts at a young age often goes away by the time the child becomes a teenager. Some people get eczema when they become a teenager or older. You may have problems with eczema all of your life.

Causes:

The cause of eczema is unknown. You are more likely to have it if your parent or another family member has eczema, hayfever, or asthma. Certain conditions and substances called "triggers" may cause your eczema to flare-up. They are:

  • Dry skin. Your skin can dry out from too much bathing or showering or not keeping your skin moisturized. A child may also get a rash if he drools or licks his lips too often.
  • Infections (in-FECK-shuns). You may get eczema after having a cold, flu, or skin infection, such as athlete's foot or a cold sore.
  • Extreme temperatures. This includes being outside in hot or cold weather, sweating too much, or dressing too warmly.
  • Allergies and sensitivities. Fragrances (perfumes), dyes, and preservatives (chemicals to keep products fresh) are added to many every day products. These include products like soap, hair dyes, make-up, or lotion. Your skin may be irritated if it is wet too often or exposed to chemicals like oils, turpentine, or paints. Other irritants that may cause eczema flare-ups are certain foods, pollen, mold, dust mites, and furry or hairy pets.
  • Rough, scratchy items. These include wool or stiff, scratchy clothing or bed linens.
  • Emotional stress. You may feel frustrated, angry, embarrassed, or self-conscious because of your eczema. You may feel stressed about something that is happening in your family, school, or job. You may feel very tired because you have not been able to sleep well. A child may feel stressed about something that is happening with his friends, school, or family.

Signs and Symptoms:

Eczema is usually very itchy. It may be red, pimpled, blistered, or oozing (leaking fluid) with crusts. Over time, your eczema may become dark red or brown, thick, cracked, or scaly. It may hurt when touched or may feel hot. Skin that becomes very damaged (hurt) by eczema may fade and look pale after the rash is gone. Eczema on babies usually appears on the face, scalp (skin on the head), or any areas that are easily rubbed or scratched. Eczema may appear anywhere on the body. On older children and adults, it often appears on the hands, feet, and areas that bend or flex. These include eyelids, ankles, wrists, armpits, fronts of elbows, and behind the knees. Itching may be worst at night. It can be so miserable that people have a difficult time sleeping.

Wellness Recommendations:

Avoid long showers or baths in hot water as these can worsen eczema symptoms. Use a moisturizing lotion after bathing.

Medical Care:

There are many creams, including steroid creams, used to treat eczema. While steroid creams are helpful, other health problems may occur with long term use. Ultraviolet light treatments are sometimes used. You may need to take medicine by mouth if your eczema is bad.

Dietary Measures:

  • Some foods may cause eczema. Keep a food diary to learn if a food causes an eczema flare-up.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Supplements:

  • Fish oils may be helpful for eczema and have been studied in people.
  • Gamma-oryzanol may be helpful for eczema and has been studied in people.
  • Probiotics are "friendly bacteria" (lactobacillus and bifidus) and may be helpful for eczema and have been studied in children and adults.
  • Vitamin A has been used, but has not been studied in people with eczema.
  • Zinc has been used, but has not been studied in people who have eczema.

Complementary Therapies:

  • Biofeedback can be helpful for eczema.
  • Hypnosis may help eczema.

Other ways of treating your symptoms:

Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

  • You would like medicine to treat atopic dermatitis.
  • You cannot sleep because you have bad skin itching.
  • Your skin rash is not better after 7 days of treatment or is worse.
  • Your skin rash has pus coming from it or has soft yellow scabs on it.
  • Your symptoms have not gone away or improved by these self-help measures.
  • You have questions about what you have read in this document.

SEEK CARE IMMEDIATELY IF:

Call 911 or O (operator) if you have the following EARLY signs or symptoms that may mean you are having an anaphylactic reaction. Do not drive yourself.

  • Swollen lips or tongue.
  • Trouble breathing or swallowing.
  • Abdominal (belly) pain.

Care agreement: You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

1. Arkwright PD, Patel L & David TJ: Dietary management of atopic eczema: is this justified? Hosp Med 1998; 59(9):690-692.

2. Fujiwaki T & Furusho K: An open study of gamma-oryzanol as a bath product for children with atopic dermatitis. Acta Paediatr Hungarica 1993; 33(3-4):287-298.

3. Hajek P, Jakoubek B & Radil T: Gradual increase in cutaneous threshold induced by repeated hypnosis of healthy individuals and patients with atopic eczema. Percept Mot Skills 1990; 70(2):549-550.

4. Isolauri E, Arvola T, Sutas Y et al: Probiotics in the management of atopic eczema. Clin Exp Allergy 2000; 30(11):1604-1610.

5. Kalliomaki M, Salminen S, Arvilommi H et al: Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet 2001; 357(9262):1076-1079.

6. McMenamy CJ, Katz RC & Gipson M: Treatment of eczema by EMG biofeedback and relaxation training: a multiple baseline analysis. J Behav Ther Exp Psychiatry 1988; 19(3):221-227.

7. Sampson HA: Food hypersensitivity and dietary management in atopic dermatitis. Pediatr Dermatol 1992; 9(4):376-379.

8. Soyland E, Rajka G, Bjornebog A et al: The effect of eicosapentaenoic acid in the treatment of atopic dermatitis: a clinical study. Acta Derm Venerol 1989; 144:139.

9. Wright S & Burton JL: Oral evening-primrose-seed oil improves atopic eczema. Lancet 1982; 2(8308):1120-1122.


Last Updated: 11/4/2014

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