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Eczema

Understanding Atopic Dermatitis/Eczema

Atopic dermatitis is a chronic (long-lasting) disease that affects the skin. The word “dermatitis” means inflammation of the skin. “Atopic” refers to diseases that are hereditary, tend to run in families, and often occur together. These diseases include asthma, hay fever, and atopic dermatitis. In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, cracking, weeping, crusting, and scaling. Atopic dermatitis most often affects infants and young children, but it can continue into adulthood or show up later in life. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, which are followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis enter into a permanent remission of the disease when they get older, although their skin often remains dry and easily irritated. Environmental factors can activate symptoms of atopic dermatitis at any time in the lives of individuals who have inherited the atopic disease trait.

What causes atopic dermatitis?

The cause of atopic dermatitis is unknown, but the disease seems to result from a combination of genetic (hereditary) and environmental factors. Evidence suggests that the disease is associated with other so-called atopic disorders such as hay fever and asthma, which many people with atopic dermatitis also have. In addition, many children who outgrow the symptoms of atopic dermatitis go on to develop hay fever or asthma. Although one disorder does not cause another, they may be related, thereby giving researchers clues to understanding atopic dermatitis. In the past, it was thought that atopic dermatitis was caused by an emotional disorder. We now know that emotional factors such as stress can exacerbate, but do not cause the condition.

What is the difference between atopic dermatitis and eczema?

Eczema is a general term for many types of skin inflammation (dermatitis). Atopic dermatitis is the most common of the many types of eczema. Several other forms have very similar symptoms. The diverse types of eczema are listed and briefly described below.

Types of Eczema

  • Atopic dermatitis: a chronic skin disease characterized by itchy, inflamed skin.
  • Contact eczema: a localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (an allergy-causing substance) or with an irritant such as an acid, a detergent (soap, bodywash), or other chemical.
  • Allergic contact eczema: a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions
  • Seborrheic eczema: a form of skin inflammation of unknown cause that presents as yellowish, oily, scaly patches of skin on the scalp, face, and occasionally other parts of the body (called cradle cap in infants).
  • Nummular eczema: coin-shaped patches of irritated skin, most commonly on the arms, back, buttocks, and lower legs-that may be crusted, scaling, and extremely itchy.
  • Neurodermatitis: scaly patches of skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite) that becomes intensely irritated when scratched.
  • Stasis dermatitis: a skin irritation on the lower legs, generally related to circulatory problems.
  • Dyshidrotic eczema: irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and burn.

How common is atopic dermatitis?

Atopic dermatitis is very common. It affects males and females equally and accounts for 10 to 20% of all referrals to dermatologists (doctors who specialize in the care and treatment of skin diseases). Atopic dermatitis occurs most often in infants and children and its onset decreases substantially with age. Scientists estimate that 65 percent of patients develop symptoms in the first year of life, and 90 percent develop symptoms before the age of 5. Onset after age 30 is less common and often occurs after exposure of the skin to harsh conditions. People who live in urban areas and in climates with low humidity seem to be at an increased risk for developing atopic dermatitis. About 10% of all infants and young children experience symptoms of the disease. Roughly 60% of these infants continue to have one or more symptoms of atopic dermatitis even after they reach adulthood. This means that more than 15 million people in the United States have symptoms of the disease.

How can Atopic Dermatitis/Eczema be treated?

There are currently many "standard" forms of treatment for atopic dermatitis and/or eczema. Topical corticosteroids are the most common prescription drugs used to control flare ups, but these cannot be used long term due to detrimental side effects. Newer prescription treatments for eczema include Protopic and Elidel. Both of these topical drugs are immunosuppressive and can cause a lowering of the patient's ability to fight off infection. Of the common OTC products available to treat eczema, probably one of the best, and certainly one of the most gentle, is colloidal oatmeal. The FDA has, in fact, made colloidal oatmeal an OTC drug for the treatment of eczema, even when used in a formulation at a concentration of less than 0.1%. The use of oatmeal baths and oatmeal lotions to calm skin and reduce the symptoms of many kinds of dermatitis has been a common treatment for 100 years, and the company  Aveeno, was built around the development of oatmeal based skin care products.

Certainly, one of the best ways to address eczema, is to simply keep the skin moisturized and hydrated so that the skin protective barrier, the stratum corneum, can heal. Cracks in the stratum corneum lead to water loss from the skin and this can trigger an inflammatory response, which then makes the skin condition progressively worse. By allowing the skin's barrier to heal, many believe that this is all that is needed to eliminate eczema. Many products on the market today contain ceramides, that are an integral component of the stratum corneum. The belief is that by supplying ceramides topically, these compounds will help repair the stratum corneum and by doing so, reduce the symptoms of eczema.