Atopic Dermatitis (Eczema)

Atopic dermatitis, also known as eczema, is a skin condition that leads to dryness, itching, and inflammation. Though it commonly affects young children, it can develop at any age. This is a chronic condition, meaning it lasts for a long time and may periodically flare up. While it can be bothersome, it is not contagious.

People with atopic dermatitis are more likely to develop conditions such as food allergies, hay fever, or asthma.

Causes of Atopic Dermatitis (Eczema)

Atopic dermatitis can stem from various factors, primarily genetic and environmental. For some people, a variation in certain genes affects the skin’s ability to act as a protective barrier. When this barrier is weak, the skin struggles to retain moisture and is less effective in shielding against bacteria, allergens, irritants, and environmental factors like tobacco smoke.

In other cases, excessive growth of the bacteria Staphylococcus aureus on the skin plays a role. This bacterial imbalance can replace helpful bacteria and disrupt the skin’s natural defenses.

A compromised skin barrier might also trigger an immune system response, leading to inflammation and other common symptoms of eczema.

Types of Dermatitis

Atopic dermatitis is one type of dermatitis. Other common types include:

Contact dermatitis: A reaction caused by direct contact with an allergen or irritant.
Seborrheic dermatitis: Commonly known as dandruff, this condition affects areas rich in oil glands.

None of these forms of dermatitis are contagious.

Symptoms of Atopic Dermatitis

Eczema symptoms can appear on any part of the body and vary from person to person. Common signs include:

Dry, cracked skin
Persistent itching (pruritus)
Rashes on swollen areas of skin, with different colors depending on skin tone
Small, raised bumps, more noticeable on darker skin tones
Oozing and crusting on affected areas
Thickened or leathery skin
Darkened skin around the eyes
Raw or sensitive skin due to scratching

Atopic dermatitis typically begins in children under 5 years old but can continue into adolescence and adulthood. Some individuals may experience periods of remission, where symptoms disappear for a while, only to return later.

Risk Factors

Several factors increase the risk of developing atopic dermatitis:

Personal or family history of eczema, allergies, hay fever, or asthma
Genetic predisposition to these conditions

Common Eczema Triggers

Identifying and avoiding triggers is key to managing eczema. Triggers vary between individuals, but common irritants include:

Rough wool fabrics
Dry skin
Skin infections
Heat and sweat
Stress
Cleaning products
Dust mites and pet dander
Mold
Pollen
Tobacco smoke
Cold, dry air
Fragrances and other irritating chemicals

Eczema in Infants and Children

Certain foods, like eggs and cow’s milk, can trigger eczema flare-ups in infants and children. It’s important to work with a healthcare provider to identify and manage potential food allergies.

Once you’ve identified your eczema triggers, discuss management strategies with your healthcare provider to better control symptoms and reduce flare-ups.

Diagnosis of Atopic Dermatitis

To diagnose atopic dermatitis, healthcare providers typically begin by discussing symptoms, examining the skin, and reviewing medical history. They may recommend specific tests to identify allergies or rule out other skin conditions.

Patch Testing: In some cases, patch testing is performed. Small amounts of different allergens are applied to the skin and covered. The doctor examines the skin over several days to check for allergic reactions, helping to identify triggers.

Treatment Options

Atopic dermatitis treatments often begin with self-care practices like regular moisturizing. If these are ineffective, medicated creams or other therapies might be recommended. The condition can be persistent, so long-term management and trying different treatments may be necessary.

Medications

Topical Medications: These help control itching and repair skin damage. Options include corticosteroid creams, gels, or ointments. Calcineurin inhibitors like tacrolimus (Protopic) or pimecrolimus (Elidel) are alternatives but should be used with caution due to potential risks.
Antibiotics: If an infection occurs, antibiotics may be prescribed.
Oral Anti-inflammatory Medications: For severe cases, drugs like cyclosporine, methotrexate, or prednisone may be prescribed, though long-term use is limited due to side effects.
Biologic Injections: Dupilumab (Dupixent) and tralokinumab (Adbry) are injectable options for moderate to severe eczema. These are considered safe and effective for individuals who don’t respond to other treatments.

Therapies

Wet Dressings: This intensive therapy involves applying medicated ointment and wrapping the skin with wet and dry gauze.
Light Therapy: Controlled exposure to natural or artificial ultraviolet light can help, though it carries risks like skin aging and cancer.
Counseling: Therapy or counseling can help manage emotional challenges associated with eczema.
Relaxation Techniques: Behavior modification and biofeedback can help reduce habitual scratching.

Baby Eczema

Treatment for infants includes avoiding irritants, controlling environmental factors, and using gentle skin care. In some cases, prescription medications or oral antihistamines may be required to control symptoms and improve sleep.

Lifestyle and Home Remedies

Moisturize Regularly: Apply a product that works well with your skin type at least twice a day.
Anti-itch Creams: Nonprescription hydrocortisone creams can help relieve itching.
Antihistamines: Medications like cetirizine (Zyrtec) or fexofenadine (Allegra) help with itch relief, especially at bedtime.
Daily Bathing: Use warm water and gentle, non-soap cleansers. Avoid harsh soaps that dry the skin.
Bleach Baths: Diluted bleach baths may help with severe flares by reducing bacteria on the skin.
Humidifiers: Using a humidifier can add moisture to dry indoor air, reducing skin dryness and irritation.

Alternative Medicine Approaches

Cannabinoid Creams: Shown to reduce itching and skin thickening in some studies.
Natural Oils: Soybean and mineral oils can help alleviate dry skin.
Manuka Honey: When applied to the skin, manuka honey has antimicrobial properties.
Acupuncture/Acupressure: May reduce itchiness in some individuals.

Complications

Eczema can lead to various complications, including:

Asthma and Hay Fever: Many individuals with eczema eventually develop asthma or hay fever, either before or after their eczema symptoms appear.
Food Allergies: Eczema sufferers are prone to developing food allergies, often marked by hives (urticaria).
Chronic Itchy, Scaly Skin: Known as neurodermatitis, this condition begins with an itch that scratching temporarily relieves, but scratching only worsens the itching over time. The affected skin can become thick, leathery, and discolored.
Post-inflammatory Pigmentation: After a rash heals, patches of skin may appear darker (hyperpigmentation) or lighter (hypopigmentation), especially in individuals with darker skin tones. These changes can take months to fade.
Skin Infections: Repeated scratching can break the skin, leading to open sores and cracks, which increase the risk of bacterial and viral infections. In severe cases, these infections may spread and become life-threatening.
Irritant Hand Dermatitis: Common in people whose hands are frequently wet or exposed to harsh chemicals like soaps or disinfectants, this form of eczema can be particularly persistent.
Allergic Contact Dermatitis: People with eczema are more likely to develop rashes from touching allergens, with the rash’s appearance varying depending on skin color.
Sleep Problems: The constant itchiness of eczema can interfere with restful sleep, leading to additional complications.
Mental Health Issues: Chronic eczema is linked to anxiety and depression, often caused by the discomfort and sleep disruptions associated with constant itching.

Prevention Tips

To prevent eczema flare-ups, establishing a consistent skin care routine is crucial. Here are some practical tips:

Moisturize Regularly: Apply moisturizers like creams, ointments, shea butter, or lotions at least twice a day to lock in moisture. Opt for products that are safe, effective, and unscented.
Use Petroleum Jelly for Infants: For babies, applying petroleum jelly may help prevent the onset of eczema.
Daily Baths or Showers: Bathe in warm, not hot, water for about 10 minutes. Avoid prolonged exposure to hot water as it can dry out the skin.
Gentle Cleansers: Use mild, non-soap cleansers free of dyes, alcohols, and fragrances. For young children, warm water alone may be sufficient. Harsh soaps, especially deodorant or antibacterial varieties, can strip the skin of its natural oils.
Pat Skin Dry: After bathing, gently pat your skin with a soft towel. Apply a moisturizer immediately while the skin is still damp to seal in hydration.

When to Consult a Doctor

It’s important to seek medical advice if:

You or your child shows signs of atopic dermatitis
The condition is causing significant discomfort, affecting sleep or daily activities
A skin infection is present, identified by symptoms such as pus, yellow scabs, or red streaks
Symptoms persist despite trying at-home treatments

In cases where a fever accompanies the rash, and it appears infected, seek medical attention immediately.

Living with Atopic dermatitis

Living with atopic dermatitis can be challenging, especially for adolescents and young adults. Talking with a therapist or support group can help manage emotional distress. Support groups provide connection with others who understand the condition.

Sources:

Mayo Clinic (Expert Opinion by O. Sokumbi, 2022)
Ash S, et al. Comparison of bleach, acetic acid, and other topical treatments. Pediatric Dermatology (2019)
National Eczema Association: Eczema and Bathing
Lebwohl MG, et al. Treatment of Skin Disease: Comprehensive Therapeutic Strategies (6th ed., 2022)
National Eczema Association: Eczema in Skin of Color (2019)
Kelly AP, et al. Taylor and Kelly’s Dermatology for Skin of Color (2nd ed., 2016)
Chan LS, et al. Complementary and alternative approaches. Atopic Dermatitis, Therapeutic guideline overview. Atopic Dermatitis, Topical therapies. Atopic Dermatitis, Clinical evidence: External factors. Atopic Dermatitis: Inside Out or Outside In? (2023)
Stander S. Atopic dermatitis. The New England Journal of Medicine
American Academy of Dermatology Guidelines (2022)
Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (9th ed., 2019)
Waldman RA, et al. Atopic dermatitis — Face. Dermatology for the Primary Care Provider (2022)
New drug for atopic dermatitis. AJN (2022)

Atopic Dermatitis