ECZEMA OR ATOPIC DERMATITIS

This is an all too common skin condition, sometime referred to as the itch that rashes. It can occur at any age and take many forms making diagnosis sometimes difficult.

THE BASIS OR MECHANISM OF ATOPIC DERMATITIS

A combination of inheritance, environmental background and "triggers" forms the basis of atopic dermatitis.

Often a close relative has an atopic disease such as eczema (dermatitis), allergic rhinitis, asthma or acid reflux.

Recent information suggests that excessive hygiene, early exposure to antibiotics and little contact with other children in early infancy predisposes children to atopic diseases that are being seen more often than before in Western developed countries. A study from Europe has shown that dosing mother and infant with harmless bacteria, Lactobacillus - probiotic, during pregnancy and for the first 6 months of the infant's life reduces the incidence of eczema by 50%.

Viral infections, exposure to allergens and to tobacco smoke and indoor and outdoor pollutants are known to "trigger" atopic dermatitis. Dry conditions are aggravating.

SYMPTOMS AND SIGNS

A rash is usually the first sign of atopic dermatitis, but some children show only dry skin initially. The typical rash is a plaque-like dry area that itches. Infants may have dry, scaly, red cheeks. Older children typically have red, itchy areas behind the knees and in front of the elbows. The rash can occur anywhere including in the ear canals and round the eyes. Typically the diaper area of infants is spared as a testimony to the value of keeping the skin moist.

Association - Atopic dermatitis, acid reflux, allergic rhinitis and

asthma are related disorders in that an individual patient may have two or more of these conditions at the same time or during different times in their lives. The simultaneous occurrence of these in the same patient is more than coincidental and one or more of the disorders may be present in other family members.

LEVELS OF SEVERITY

The degree of severity of atopic dermatitis dictates the way it is treated.

THINGS THAT INCITE OR AGGRAVATE ATOPIC DERMATITIS

The recognition of things that incite the rash is an important aspect of management since the avoidance or control of these may prevent or minimize occurrences. Parents and patients should be alert to those events that aggravate atopic dermatitis:

• Contact with cigarette smoke or the clothing of a smoker
• Contact with hair-bearing animals pets or clothing of those handling such an animal
• Contact with certain types of clothing
• Eating certain foods
• Exposure to the dry environment of the typical winter home here in Montana.

PREVENTION & TREATMENT

Moisturizing emollients, topical steroids or immune suppressant, anti-histamines and sedatives are used to treat atopic dermatitis.

Keeping the skin moist is pivotal in the management. This is accomplished by applying emollients, that trap moisture in the skin, twice daily to the entire body. It is essential that an emollient be applied immediately [within 5 minutes] after bathing. Baths and showers should be relatively brief since they are drying.

Inexpensive, but very effective, emollients include:

• Petrolatum
• Vegetable shortening like Crisco

Others include thick lotions and creams. There are many, but we list a few:

• Keri Curel Eucerin
• Valsoline Intensive Care Lubriderm

Topical steroids or an immune suppressant are the mainstay of treatment the type being dictated by the severity of atopic dermatitis, its distribution and past experience with topical treatments. High potency steroids should not be used on the face or the ante-cubital fossae [the front of elbows] since they may cause changes in the skin. The immune suppressant currently available is approved for application to these areas.

Best results of treatment are attained by:

• avoiding or minimizing triggers,
• applying the topical steroid or immunosuppressant prescribed by your doctor 2-3 times a day to areas affected by a rash. When the rash has faded the topical agent should be applied to the previously affected area for an additional week and then discontinued.
• applying an emollient to the entire body over-coating the topical agent 2-3 times a day on a daily basis even when there is no rash.

If atopic dermatitis cannot be controlled in this way after a good effort of a week to 10 days a different topical agent or additional medication may be needed. Work with your child's doctor on this.

The role of a probiotic such as Lactobacillus (as in acidophilus) in the treatment of atopic dermatitis is not yet clear. Some parents indicate that a daily dose of acidophilus has a clearing effect on their child's rash.

The role of anti-yeast medication is also unclear at this time.

Nov. 2001

©2002 South Valley Pediatrics
page updated April 7, 2002