Atopic eczema is like an ‘asthma of the skin’

Eczema and dermatitis are both terms with the same meaning; inflammation, redness, and itching of the skin. Atopic eczema (a.k.a. atopic dermatitis) is a skin disease. The first sign of eczema tends to be patches of dry or red, itchy skin.

Unfortunately, because dermatitis can be so itchy, aggressive scratching can actually injure the skin and worsen the condition. Sometimes the itch can precede the rash. Some doctors say atopic eczema is “the itch that rashes.”

Atopic eczema usually begins very early in life as an infant or young child, but it can occur at any age. It is common in infants and young children, and most people who get eczema will have it before they turn five years old. It is rare for eczema to appear for the first time as an adult.

Eczema tends to come and go, often without warning. A treatment plan that includes skin care can reduce flare-ups and ease much of the discomfort.

What causes eczema?

Atopic eczema is a genetic condition. It is often seen in patients whose family members have it or other related conditions such as asthma, hay fever or allergic rhinitis. Some patients may have atopic eczema alone or with several or all of these other conditions.

There is emerging evidence that patients with atopic eczema may have a mild disability to repair their skin barrier. Also, excessive bacteria on the skin with bacterial enzymes (proteases) can make eczema worse.

Atopic eczema is not contagious. Dry skin, dry weather, perspiration, and illness are several things that can cause atopic eczema to get worse.

How can I tell if my child has eczema?

Atopic eczema presents as red, flakey, itchy patches. In children it commonly appears on the folds of the elbows and knees and on the scalp, forehead and cheeks, but it can be present anywhere. Atopic eczema itches so much that infants commonly rub their cheeks on bed linens or even carpeting for relief.

In extreme cases, a yellow fluid may even weep from the involved areas. Scratching over extended periods of time will cause the skin to become tough and thicken up. This is a common finding in patients with longstanding eczema that has not been completely controlled.

If you think that your child has atopic eczema, visit a board-certified dermatologist to make sure the diagnosis is correct. A dermatologist can often diagnose eczema by examining the patient’s skin, as well as by asking historically significant questions about a family history of similar skin rashes or asthma or hay fever.

How long will my child have eczema?

In most children, atopic eczema may get better over time, but their skin will always be more sensitive than those without atopic eczema, even as adults.

How is eczema treated?

A dermatologist will create a specific treatment for the patient with atopic eczema. Most treatment plans consist of:

• General skin-care program
• Medical treatments
• Tips to avoid flare-ups

There is no one treatment for atopic eczema. It is important to follow the treatment plan designed by your dermatologist and the success in adequately managing atopic eczema depends on carefully following the treatment plan.

What will the treatment plan include?

• Extreme Moisturizer and/or emollient. I recommend bathing DAILY and then immediately sealing in the skin hydration with a rich cream; some call this “soak and seal.” Keeping the skin hydrated is one of the safest and most effective strategies in treating atopic eczema. It minimizes flare-ups and makes the skin more comfortable.
• Gentle non-detergent cleanser to reduce irritation and skin dryness.
• Topical steroidal or non-steroidal creams or ointments for inflammation and itch control.
• Antihistamine for itch and sleep.
• Wet wraps for the skin to hydrate and make the other medicines penetrate and work better.
• Bleach baths (very diluted) to reduce the bacteria on the skin that can make atopic eczema worse. It is important to also wash pajamas and bed linens on the same day as the weekly bleach bath for maximum effectiveness.
• Antibiotics to reduce bacteria and also work as non-steroidal anti-inflammatory medicine.
• Systemic medications when the condition is severely flaring and other agents are not helping. These medicines can be very strong, and your dermatologist will explain the risks and benefits of such a treatment.
• Phototherapy treatments. This is a very safe, effective, steroid-sparing treatment that can greatly help in the treatment of atopic eczema.

Why see a dermatologist?

When a child has atopic eczema, it is a condition that really affects the entire family. It takes time away from other siblings and caregivers and can affect performance in school.

As a dermatologist, I like to tell parents atopic eczema is like having “asthma of the skin.” Just like asthma, it can wax and wane and have certain triggers. Just like asthma, it is a lifelong condition that needs attention but over time may improve.

With so much information out there, much of it misleading or downright inaccurate, it can be challenging for a parent to know exactly what to do. Dermatologists specialize in treating skin conditions and can help parents make the best informed decisions for their children.

A dermatologist can develop s specific treatment plan for the atopic eczema patient. Research has shown that parents who develop a good relationship with their dermatologist and follow a designed treatment plan will have the most success in treating their child’s atopic eczema over time.

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.