Eczema / Atopic Dermatitis
Eczema (pronounced
"EK-zema") , also known as atopic dermatitis, is one of the most common skin
diseases in the United States. The condition affects nearly 9% of the
overall U.S. population and 15% of children. Eczema falls into a category of
diseases called atopic, a term originally used to describe the allergic
conditions asthma and hay fever.
Eczema almost always begins in childhood, usually
during infancy. Its symptoms are dry, itchy, scaly skin, cracks behind the
ears, and rashes on the cheeks, arms, and legs. It alternately improves and
worsens. It’s seldom present at birth, but it often comes on after six
weeks.
The skin’s main function is to provide a barrier against dirt, germs and
chemicals from the outside. We don’t notice this barrier unless it gets dry,
and then it’s scaly, rough and tight. Dry skin is brittle — moist
skin is soft and flexible. People with eczema have a defect in
their skin and it won’t stay moist. It is especially bad in winter when the
heat is on in the house and the humidity drops. Other things that dry the
skin are bathing without proper moisturizing.
Eczema is a very itchy rash. Much of the skin damage comes from scratching
and rubbing that cannot be controlled.
During "flare-ups," open weeping or crusted sores may develop from the
scratching or from infections. Eczema can also be a sign that other allergic
conditions are present, such as food allergies, allergic rhinitis and even
asthma. Skin symptoms may get worse after eating.
Eczema is not contagious. Research indicates that atopic diseases like
Eczema are genetically determined, inherited from one’s parents. A child
with one parent who has an atopic condition has a one-in-four chance of
having some form of atopic disease. If both parents are atopic, the child
has a greater than one-in-two chance of being atopic.
Triggers
Trigger factors may be different for different people. Most get worse when
they get a cold or other infection. Most have worse problems in the winter;
but others simply can’t stand the sweating during hot, humid summer weather.
Let’s look at the trigger factors that seem to affect every child with
eczema.
Irritants are any of the substances outside the body that can cause burning,
redness, itching or dryness of the skin. The challenge: Avoid irritating
substances.
Stress. Emotional stress comes from many situations. People with AD often
react to stress by having red flushing and itching. Special problems for
children with AD include frustration, anger or fear, such as when getting
the "silent treatment" from a parent. And, of course, AD itself, and its
treatments, are a source of stress! The challenge: Recognize stress and
reduce it.
Heat and sweating. Most people with atopic dermatitis notice that when they
get hot, they itch. They have a type of prickly heat that doesn’t occur just
in humid summertime but any time they sweat. It can happen from exercise,
from too many warm bedclothes or rapid changes in temperature from cold to
warm.
Infections. Bacterial "staph" infections are the most common, especially on
arms and legs. Such infections might be suspected if areas are weeping or
crusted or if small "pus-bumps" are seen. Herpes infections (such as fever
blisters or cold sores) and fungus (ringworm or athlete’s foot) can also
trigger AD. If some lesions look different, ask your doctor. If they turn
out to be infected, they can be treated with antibiotics. Recognize and
treat pustules or crusted lesions.
Allergens. Allergens are materials such as pollen, pet dander, foods, or
dust, that cause allergic responses. Allergic diseases such as asthma and
hay fever, which flare quickly, are easy to tie to allergens. Itching and
hives appear soon after exposure to these airborne allergens and last only
briefly. The slower, continuing, chronic eczema of AD may be more difficult
to tie to specific allergens. Foods, dust mites and pets can trigger eczema
in many patients. Avoidance of foods is not recommended with out proper
diagnosis. If a food allergy is diagnosed most all patients react to only
1-2 food families. It is extrodinarly rare to have an allergy to a large
number of foods.
Allergy diagnosis (click here to learn more)
A skin test, made by scratching the skin with the suspected allergen, is
helpful if the test is negative (indicating that the particular food will
not affect the patient). If the scratched area becomes inflamed, the test is
considered positive. Unfortunately, positive results are difficult to
interpret and are falsely positive 50% of the time and possibly more.
Positive tests provide a clue to a possible allergy but need to be
confirmed. Additionally, because the skin of AD sufferers is so sensitive,
simply scratching it can cause inflammation, making the likelihood of a
false-positive skin test even higher.
A blood test is another type of test to detect food allergies. Blood tests,
also, have a false positive rate higher.
These tests are difficult to interpret and requires experience and training
to make an accurate diagnosis. Any positive test must be confirmed by a
challenge. There is a great likely hood that a positive test will not cause
any symptoms so avoiding a food may not help you in any form.
Can sufferers of AD live normal lives?
Yes! People with AD do not have to be limited by their disease. It can be
controlled by prevention, medication, and careful adherence to a treatment
program consisting of: skin hydration, itch control, inflammation control.