5 Questions to Ask About Atopic Dermatitis (Eczema)

Atopic dermatitis (Eczema) is the most common skin condition that allergists usually treat. It is especially prevalent in childhood where it affects one in five infants but only around one in fifty adults. Patients typically present with red, irritated, itchy skin that can be chronic in nature, oftentimes with cracks. The affected skin becomes prone to irritation and inflammation often triggered by environmental factors. In about half of patients with severe atopic dermatitis, the disease is due to inheritance of a faulty gene in their skin called filaggrin. Unlike hives, the itch of eczema is not only caused by histamine so anti-histamines may not control the symptoms. Eczema is often associated with asthma, allergic rhinitis (hay fever) or food allergy.

For many years, eczema was thought to be caused by something the patient ate. To this day, many parents will want to know “what food is causing the eczema?” Some young children with eczema do indeed have food sensitivities which can make eczema symptoms worse.

It is now thought however, that atopic dermatitis is caused by “leakiness” of the skin barrier, which causes it to dry out and become prone to irritation and inflammation. A few known triggers for atopic dermatitis include exposure to allergens such as pet dander, pollen, peanuts, stress, infection, or foods. Various fabrics, household cleaners, and soaps can be skin irritants causing the atopic dermatitis to flare.

Some of the most common symptoms of atopic dermatitis include itchy, dry skin that will appear on the face, behind the knees, and on the inside of the elbows. However, atopic dermatitis can appear anywhere on the body. Weeping, oozing and crusting of the skin may also occur as well as thickening of chronically affected areas.

Individuals with atopic dermatitis are more prone to herpes and skin (viral and bacterial) infections. When it starts to appear on the eyelids, and around the eyes, it may result due to darkening of the skin (allergic shiners), cataracts, and an extra fold of skin under the eye (Dennies lines).

Often, we see atopic dermatitis starting in early childhood, but it can affect anyone of any age. Most children will see a significant improvement in their condition as they go through adolescence but ~10% of patients will have symptoms continuing into adulthood.

Eczema is a broad term that is used to refer to inflammation of the skin. Skin dryness, redness, and itchiness are some of the most common symptoms of eczema, but scaling, blisters, and flaking can also appear.

Atopic dermatitis can be temporary; however, when it occurs on a much more chronic and longer-lasting basis, it will usually be referred to it as eczema. There are many different forms of eczema, with the most common form of eczema being atopic dermatitis.

Atopic dermatitis is one of the most common occurrences among individuals with a family or personal history of asthma or hay fever, as often the conditions will occur together.

There are various treatment strategies that can help with atopic dermatitis.

– Daily soaking/bathing
– Regular use of moisturizers
– Oral antihistamines to control itch
– Topical steroids (Hydrocortisone, Aclovate, Triamcinolone..)
– Topical Non- steroids (Protopic, Elidel, Eucrisa…)
– Antibiotics- oral or topical — Bleach baths
– Biologics (Dupixent, Cibinqo, Rinvoq)