Alternate Names: Infantile eczema; Atopic eczema; Dermatitis - atopic; Eczema; Eczema - infantile; Eczema - atopic

Causes and Risks:

Atopic dermatitis can occur in infantile (children), or adult form. It is most common in infants, and at least half of those cases clear by age 36 months. There is often a family history of asthma, hay fever, or atopic dermatitis. In adults, it is generally a chronic or reoccurring condition.

A hypersensitivity reaction (similar to an allergy) occurs in the skin, causing chronic inflammation. The inflammation causes the skin to become itchy and scaly. Chronic irritation and scratching can cause the skin to thicken and become leathery-textured.

Exposure to environmental irritants can worsen symptoms, as can dryness of the skin, exposure to water, temperature changes, and stress.

Prevention: There is no known prevention. The condition tends to run in families. Control of stress and emotional conditions (nervousness, anxiety, depression, etc.) can be beneficial in some cases.

Symptoms:

• Intense itching
• Blisters (vesicle formation) with oozing and crusting
• Skin redness or inflammation around the blisters
• Rash
  • In children under 2 years old, skin lesions begin on the cheeks, elbows, or knees
  • In adults, the rash more commonly involves the flexor (inside) surfaces of the knees and elbows
• Dry, leathery skin areas (lichenification)
  • More or less pigment than their normal skin tone (see skin, abnormally dark or light)
  • Located commonly in the inner elbow or behind the knee
  • May spread to the neck, hands, feet, eyelids, or behind the knee
• Raw areas (excoriation) of the skin -- from scratching
• Ear discharges/bleeding

Signs and Tests: Diagnosis is primarily based on the appearance of the skin and on personal and family history. The health care provider should examine the lesions to rule out other possible causes. A skin lesion biopsy may be performed, but is not always required to make the diagnosis.

Treatment:

Consult your health care provider for diagnosis of atopic dermatitis because it can be difficult to differentiate from other skin disorders. Treatment should be guided by the health care provider.

The goal of treatment is reduction of symptoms.

Treatment may vary depending on the appearance (stage) of the lesions -- acute weeping lesions, dry scaly lesions, or chronic dry, thickened lesions are each treated differently.

Atopic dermatitis usually responds to home treatment which is designed around the chronic nature of the disease. Anything that aggravates the symptoms should be avoided whenever possible, including any food allergens and environmental irritants such as wool and lanolin.

Dry skin often makes the condition worse, so bathing and the use of soaps may be reduced. Temperature changes and stress may cause sweating and changes in the blood vessels of the skin, also aggravating the condition.

If avoidance of irritants does not reduce symptoms, treatment applied to a localized area of the skin (topical) may be indicated. Topical treatment of weeping lesions may include soothing moisturizers, mild soaps, or wet dressings.

Mild anti-itch lotions or topical steroids (corticosteroids-topical-low potency) may soothe less severe or healing areas, or dry scaly lesions.

Chronic thickened areas may be treated with ointments or creams that contain tar compounds, topical steroids (corticosteroids-topical-medium to very high potency), ingredients that lubricate or soften the skin, or other ingredients. Systemic corticosteroids may be prescribed to reduce inflammation in some severe cases.

Prognosis: Atopic dermatitis is a chronic condition, but it may be controlled with treatment and avoidance of irritants.

Complications:

• Secondary bacterial infections of the skin
• Permanent scar formation

Call for an appointment with your health care provider if atopic dermatitis does not respond to moisturizers or avoidance of allergens, if symptoms worsen or treatment is ineffective, or if signs of infection (such as fever, redness, pain) occur.