Atopic dermatitis is a condition of the skin characterized by inflammatory dermatitis. This rash is often described as eczematous. As a consequence, many refer to this condition as eczema. Often this condition presents in infancy. It waxes and wanes and often goes into remission at age 5-6. Even though an older child or adult with this condition does not appear to have obvious dermatitis, their skin is very sensitive and will often develop a flare with changing environmental conditions, exposure to harsh soaps or chemicals.
In infancy, this dermatitis often presents as a rash on the face, buttocks and groin area but, may also appear in scattered areas on the arms and legs. As the child matures this often localizes to the face, neck, antecubital area of the arms and popliteal areas of the legs. In some adults who are in the food service industry or work as hairdressers and have a history of atopic dermatitis, there is often localization and exacerbation about the hands.
Causes of Eczema and Atopic Dermatitis
This disease is associated with hay fever, asthma, and other atopic signs and symptoms. The current understanding maintains that this disease results from an overactive immune system. There is also a significant barrier defect in the skin of individuals with this condition. Correction of the abnormal skin barrier function with the use of non-soap cleansers, regular bathing, and the vigorous use of moisturizers often leads to significant improvement in the patients‘ eczema. Our center highly recommends regular tepid short showers and baths with non-soap cleansers and the vigorous use of moisturizers multiple times a day and especially after bathing.* Currently, we prefer using moisturizers with ceramides which are natural lipid substances that are deficient in patients with atopic dermatitis.* We especially recommend products such as Cetaphil Restoraderm and Cerave that contain ceramides and can be particularly helpful.*
Treatments of Eczema and Atopic Dermatitis
Topical steroids are particularly helpful for the short-term treatment of atopic dermatitis.* They are ideally suited to be used over days to weeks.* However, the use of these products over months can lead to thinning and atrophy of the skin. Ideally, we recommend that they are used in strengths appropriate for the area being treated. For the face and groin, we recommend the lower strength products.* For the other areas, we often resort to the high and super-potent steroids.* These are only used for short periods of time.
Topical immunomodulators such as Protopic and Elidel are particularly useful for patients that require chronic therapy of their skin. These drugs suppress the inflammatory response without thinning the skin.* They are safe and tested in children and adults, but are not approved for use in infants.* Long- term studies have failed to prove a decisive link with the use and skin cancers or lymphoma.* When these drugs are taken by mouth by people who require immune system suppression, the side effect profile is different and patients must be watched carefully. However, with topical use in patients with atopic dermatitis, there is no data or literature to support these concerns. These drugs are particularly useful around the eyes and on the face where an even short-term use of topical steroids can be harmful.* These drugs are often also used on the face and groin by patients with psoriasis.
Systemic treatments with antihistamines are particularly helpful in patients with itchy skin associated with atopic dermatitis.* We prefer to use the non-sedating antihistamines during the day and the more sedating agents at night if necessary. Systemic steroids can be used occasionally for severe flares.* They often are helpful over a one- to two-week time. Repeated use of these agents can be associated with the development of cataracts, osteoporosis, and diabetes. There are systemic immunosuppressive agents that occasionally can be used for this condition in patients that do not respond to the other therapies.* Occasionally patients will also benefit from narrowband UVB and PUVA.* These light-based therapies suppress the overactive immune response in the skin. They are administered anywhere from 1-3 times per week during flare periods.*
Finally, infection is a particular concern in all patients with atopic dermatitis. Part of the immune surveillance system of the skin referred to as innate immunity, is compromised. This first line of defense against bacterial infections is diminished and may result in an increased risk of skin infections. Staph Aureus, especially MRSA, is a constant concern. When necessary, cultures and appropriate antibiotic therapy are an important part of the treatment of atopic dermatitis.* Our facility has found baths with ¼ to ½ cup of bleach in a tub of water useful in treating and preventing cutaneous infections.* After bathing and during the day vigorous use of moisturizers is essential in re-establishing barrier function of the skin and protecting against the development of new infections.*
Please feel free to contact us to schedule a medical appointment to discuss your eczema /atopic dermatitis treatment options in our Sacramento office.