Atopic Dermatitis (Eczema)

What is atopic dermatitis?

Atopic dermatitis, also called eczema, is a skin disorder that usually appears in babies or very young children, and may last until the child reaches adolescence or adulthood. Eczema causes the skin to itch, turn red, and flake.
 
Parents with eczema are more likely to have children with eczema. Different triggers can make eczema worse, including environmental stress, allergies, and sweating. Of children who have eczema, most will show signs of eczema in the first year of life and 90 percent will show signs of eczema within the first 5 years.
 
Eczema occurs in approximately 10 percent to 20 percent of all infants. Of these children, nearly one half will improve as they grow and develop between the ages of five and 15 years. Other children may have some form of eczema throughout their lifetime.

What are the symptoms of eczema?

The distribution of eczema may change with age. In infants and young children, eczema is usually located on the face, outside of the elbows, and on the knees. In older children and adults, eczema tends to be on the hands and feet, the arms, and on the back of the knees. The following are the most common symptoms of eczema. However, each child may experience symptoms differently. Symptoms may include:

• dry, scaly skin
• small bumps that open and weep when scratched
• redness and swelling of the skin
• a thickening of the skin (with chronic eczema)

Excessive rubbing and scratching can tear the skin and result in an infection. Some children only have a few episodes of flare-ups, while other children will have atopic dermatitis throughout adulthood.
 
The symptoms of eczema may resemble other skin conditions. Always consult your child's physician for a diagnosis.

How is eczema diagnosed?

Atopic dermatitis is very common. The National Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that at least 20 percent of infants and children experience symptoms of atopic dermatitis. Diagnosis is usually based on a physical examination and medical history. Diagnosis may also include the following:

• family history (Children born to a mother who has allergic conditions are more prone to eczema.)
  
  
• personal history of allergies or asthma
  
  
• blood tests

Treatment for eczema:

Specific treatment for eczema will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the disorder
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the reaction
• your opinion or preference

There is no cure for eczema. The goals of treatment are to reduce itching and inflammation of the skin, moisturize the skin, and prevent infection.

Management of eczema symptoms:

Developing Treatments   A new class of medications, called topical immunomodulators (TIMs), offers a steroid-free treatment option for atopic dermatitis. These medications allow application anywhere on the body to relieve itching, redness, and pain from eczema. Tacrolimus is the first TIM approved by the US Food and Drug Administration (FDA). In more than 28 worldwide studies, tacrolimus dramatically improved or completely cleared up eczema in most patients. Another new TIM, pimecrolimus, has been approved by the FDA. Side effects in both TIMs are rare.   Always consult your child's physician for more information.

The following are suggestions for the management of eczema:

• Avoid contact with irritants, as determined by your child's physician.
  
  
• Bathe your child regularly, use moisturizers, and practice good skin care techniques.
  
  
• Keep your child's room cool at night to prevent sweating that can irritate the skin.
  
  
• Do not use harsh soaps. Ask your child's physician to recommend a brand.
  
  
• Make sure your child's fingernails are short, as scratching may contribute to an infection.
  
  
• Use lubricating lotions at least once a day. Ask your child's physician to recommend a brand.

Your child's physician may also prescribe medications in severe cases. The following medications are most commonly used to treat eczema:

• antihistamines
  These medications help to decrease the amount of itching. Some examples are diphenhydramine (Benadryl®) or hydroxyzine (Atarax®). These medications may cause drowsiness. Some new antihistamines are also available that do not cause drowsiness. Consult your child's physician for more information.
  
  
• topical steroids 
  These topical medications help to decrease the inflammation in the skin, decreasing the itching and swelling. Topical steroids are the most common and best studied treatment for eczema and many topical steroids in various strengths are available. Follow the advice of your child's physician.
  
  
• oral antibiotics 
  Skin infections are common in patients with eczema and if untreated can make the eczema more severe and difficult to control. A swab from the skin area thought to be infected may be taken and cultured in a lab to determine what type of antibiotic to use for the most effective treatment. Follow the instructions for dosing and administration carefully and consult with your child's physician as needed.
  
  
• oral cyclosporine
  This medication is used primarily to prevent rejection after organ transplantation. It may also be used to treat cases of severe eczema that have not improved with other therapies. It suppresses the immune system and has other side effects that should be considered. Consult with your child's physician as needed.  
   
  
• phototherapy  (light therapy)
  It is safest to have this treatment under medical supervision, but light therapy is not offered at all dermatology clinics. Home light therapy devices are available, but may not be covered by insurance. Consult with your child’s physician for more information.
   
• topical immunomodulators (TIMs)
  Topical immunomodulators are a new class of drugs for the treatment of eczema. These drugs are applied directly to the skin to alter the immune response. Although TIMs are an effective treatment for eczema, their longterm risks are unknown. Consult with your child’s physician for more information.

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