ANSWER:
Introduction

Atopic dermatitis, also referred to as eczema, is an itchy eruption of the skin. It’s a long-lasting (chronic) condition that may be accompanied by asthma or hay fever. Atopic dermatitis is most often seen in infants and children, but it can continue into adulthood or first appear later in life.

Although atopic dermatitis may affect virtually any area, it classically involves skin on the arms and behind the knees. It tends to flare periodically and then subside for a time, even up to several years. The exact cause of atopic dermatitis is unknown, but it may result from a malfunction in the body’s immune system.

Even mild atopic dermatitis can be extremely itchy. Self-care measures, such as avoiding soaps or other irritants and applying creams or ointments, can help. See your doctor if your symptoms distract you from your daily routines or prevent you from sleeping.

Treatment

Treatments for atopic dermatitis aim to reduce inflammation, relieve itching and prevent future flare-ups. Over-the-counter (nonprescription) anti-itch creams, along with other self-care measures, may help control mild atopic dermatitis.

Although atopic dermatitis is related to allergies, eliminating allergens is rarely helpful in treating the condition.

Occasionally, items that trap dust such as feather pillows, down comforters, mattresses, carpeting and drapes can worsen the condition. Allergy shots usually aren’t successful in treating atopic dermatitis and might even make the condition worse.

Medications

Your doctor may recommend prescription corticosteroid creams or ointments to ease scaling and relieve itch. Some low-potency corticosteroid creams are available without a prescription, but you should always talk to your doctor before using any topical corticosteroid. Side effects of long-
term or repeated use can include skin irritation or discoloration, thinning of the skin, infections, and stretch marks on the skin.

If itching is severe, oral antihistamines may help. Diphenhydramine (Benadryl, others) can make you very sleepy and may be helpful at bedtime. If your skin cracks open, your doctor may prescribe mildly astringent wet dressings to prevent infection.

If these measures don’t help, your doctor may prescribe a short-course of oral corticosteroids, such as prednisone, to reduce inflammation and to control symptoms. These medications are effective but can’t be used long term because of potential serious side effects, which include cataracts, loss of bone mineral (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure and thinning of the skin.

A class of medications called immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel), affects the immune system and may help maintain normal skin texture and reduce flares of atopic dermatitis. This prescription-only medication is approved for children over the age of 2 and for adults. Due to possible concerns about the effect of these medications on the immune system when used for prolonged periods of time, the Food and Drug Administration recommends that Elidel and Protopic be used only when other treatments have failed, or if someone can’t tolerate other treatments.

Light therapy (phototherapy)

As the name suggests, this treatment uses natural or artificial light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light either alone or in combination with medications.

Though effective, long-term light therapy has many harmful effects, including premature skin aging and an increased risk of skin cancer. For these reasons, it’s important to consult your doctor before using light exposure as treatment for atopic dermatitis. Your doctor can advise you on possible advantages and disadvantages of light exposure in your specific situation.

Infantile eczema

Treatment for infantile eczema includes identifying and avoiding skin irritations, avoiding extreme temperatures, and using bath oils, lotions, creams or ointments to lubricate your baby’s skin.

See your baby’s doctor if these measures don’t improve the rash or if the rash looks infected. Your baby may need a prescription medication to control the symptoms or to treat the infection. Your doctor may recommend an oral antihistamine to help lessen the itch and to cause drowsiness, which may be helpful for nighttime itching and discomfort.

Self-care

To help reduce itching and soothe inflamed skin, try these self-care measures:

Try to identify and avoid triggers that worsen the inflammation. Rapid changes of temperature, sweating and stress can worsen the condition. Avoid direct contact with wool products, such as rugs, bedding and clothes, as well as harsh soaps and detergents.

Apply an anti-itch cream or calamine lotion to the affected area. A nonprescription hydrocortisone cream, containing at least 1 percent hydrocortisone, can temporarily relieve the itch. A nonprescription oral antihistamine, such as diphenhydramine (Benadryl, others), may be helpful if itching is severe.

Avoid scratching whenever possible. Cover the itchy area if you can’t keep from scratching it. Trim nails and wear gloves at night.

Apply cool, wet compresses. Covering the affected area with bandages and dressings can help protect the skin and prevent scratching.

Take a comfortably cool bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal a finely ground oatmeal that is made for the bathtub (Aveeno, others).

Choose mild soaps without dyes or perfumes. Be sure to rinse the soap completely off your body.

Moisturize your skin. Use an oil or cream to seal in moisture while your skin is still damp from a bath or shower. Pay special attention to your legs, arms, back and the sides of your body. If your skin is already dry, consider using a lubricating cream.

Use a humidifier. Hot, dry indoor air can parch sensitive skin and worsen itching and flaking. A portable home humidifier or one attached to your furnace adds moisture to the air inside your home. Portable humidifiers come in many varieties.
Choose one that meets your budget and any special needs. And be sure to keep your humidifier clean to ward off bacteria and fungi.

Wear cool, smooth-textured cotton clothing. Avoid clothing that’s rough, tight, scratchy or made from wool. This will help you avoid irritation. Also, wear appropriate clothing in hot weather or during exercise to prevent excessive sweating.

Good luck!
DS