Eczema/Atopic Dermatitis

Many of you have heard the terms eczema and dermatitis. They are interchangeable and both refer to skin that is inflamed. The skin may be inflamed for a variety of reasons including irritation such as exposure to harsh soaps or chemicals or the skin may be inflamed by contact with something you are allergic to such as poison oak.

When dermatologists refer to eczema we often mean a common, specific skin condition called atopic dermatitis. Atopic dermatitis typically occurs in people who have a personal or family history of asthma, hay fever, or eczema. Patients with atopic dermatitis have overly sensitive and overly reactive skin with a much lower threshold for the sensation of itching. Their skin is usually dry and has an impaired protective barrier to the environment. This makes their skin even more easily irritated that causes a worsening of their itching and their rash.

Atopic dermatitis has 3 phases in life. The initial phase starts during the first few months of life and typically affects the face and the extensor or outside surfaces of the arms and legs. The skin is red, scaly, sometimes with oozing and very itchy. These infants are often very fussy, don't sleep well, and may have difficulty with milk and some other foods.

The second childhood phase involves the flexural areas such as the inside of the elbows and wrists, behind the knees, and the neck. The skin is drier and thicker and is very itchy and may develop secondary bacterial infections.

The third adult phase usually appears as a dry, itchy, sensitive rash on the hands that are sensitive and easily irritated.

All phases of atopic dermatitis require treatment of the dryness of the skin with frequent and regular moisturization. The use of prescription topical steroid creams and ointments as well as nonsteroid anti-inflammatory creams and ointments are a mainstay of the treatment. Often oral antihistamines are needed to reduce the strong sensation of itching, and oral antibiotics are needed when infection is present. In severe cases other oral medications and ultraviolet light therapy may be needed.