Atopic dermatitis, also called atopic eczema, is a skin disorder that usually manifests itself as dry, itchy skin and/or a red, scaly rash. The term "atopic" refers an inherited ability to make IgE, the allergic antibody; "dermatitis" and "eczema" both mean inflammation of the skin. Atopic dermatitis is common, affecting 10 to 20 percent of the population in the U.S. It most often affects infants and small children, and while some patients go on to have a chronic or relapsing course, it is rare for atopic dermatitis to have new onset in an adult (this should prompt consideration of other causes of eczematous rashes). It may be the first sign that a person will go on to develop other atopic conditions such as food allergy, hay fever or asthma.
The disease can have a significant impact on the quality of life of individuals and their families. The itching can interfere with daily activities and make it hard to sleep. Scratching the rash can irritate the skin, making it itch even more, which, in turn, increases the tendency to scratch. This itch-scratch cycle can leave the skin open to infections.
There is no cure for atopic dermatitis, but there are many ways to treat it. For instance, discovering and avoiding triggers, such as irritants (e.g. detergents or various chemicals) or proven allergens that cause the illness to "flare," is vital, as is good daily skin care, which usually involves hydrating the skin and then applying a moisturizer or topical medicine. Shampoos with antidandruff action or tar products to decrease inflammation can be helpful for scalp involvement. Also, oral sedating antihistamines to control itching may be prescribed for use at bedtime.
People who seek out and get good treatment often succeed in controlling their eczema and so are able to feel good about their appearance, have restful sleep, and participate fully in family, school, and work activities.
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People with the condition often have skin that is less able to retain moisture than normal skin so it often feels dry and looks red. Eczema usually appears as a dry, scaly rash, although it can also be swollen and “weepy.”
In places where there have been repeated rashes, the skin can take on a thicker wooden-like appearance. This is known as lichenification.
The cause of atopic dermatitis is currently not known, although but it typically occurs in families with atopic diseases (atopic dermatitis, asthma and allergies) pointing to a genetic component. In the past few years, mutations in the gene for filaggrin protein which is important in building a healthy skin barrier have been described in some patients with atopic dermatitis. These patients appear to have atopic dermatitis that is earlier in onset, more severe and persistent and associated with asthma and allergic sensitization. Patients can have specific or unique triggers that make their eczema flare and these include irritants, allergens, infectious agents and emotional factors.
There are several risk factors for the condition that are not under a patient's control, including:
- A family history of the disease
- A personal history of allergic conditions, such as hay fever
- A personal history of asthma
- A personal history of food allergies
These conditions may appear in a sequence called the "atopic march." Over a period of years, a person may develop one and then another. Recognizing that a person with eczema is at a higher than normal risk of developing another of these conditions is important for parents, patients, and healthcare providers. Knowing that a patient with a slight wheeze has had a history of atopic dermatitis, for example, makes it easier to diagnose the subtle onset of asthma.
Last reviewed on 10/21/09
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