Atopic Dermatitis

Asthmatic Dermatitis, Eczema

What is Atopic Dermatitis?

Atopic dermatitis or eczema is a chronically relapsing skin disorder that begins most commonly during infancy, childhood, or adolescence. The cause of atopic dermatitis is unknown. Immunologic, genetic, physiologic, and pharmacologic factors play a role in the development of atopic dermatitis. It is often associated with personal or family history of atopic dermatitis, allergic rhinitis, allergic conjunctivitis, and/or asthma.

How is it diagnosed?

Atopic Dermatitis signs and symptoms

  • Itching rash in areas where heat and moisture are retained, such as skin creases of elbows, knees, neck, face, hands, feet, groin, genitals and around the anus.
  • Dry, thickened skin in affected areas.
  • Uncontrolled scratching (frequently unconscious).
  • Chronic fatigue from loss of sleep due to severe itching.

History: The main symptoms are itching and scratching that can be so severe as to affect sleep and quality of life.

Physical exam reveals raised bumps on the skin, thickened, red, gray or scaly skin (lichenification), red, fluid-filled bumps, and crusted lesions. Extensive fissures, weeping, and crusting may be present in advanced cases.

Tests: Some immunologic and skin testing may be required. Elevated total IgE suggests allergic cause.

How is Atopic Dermatitis treated?

No known therapy is curative. Currently, treatment consists of removal or reduction of irritating factors, use of topical corticosteroids, application of water-trapping agents such as mineral oil, and reduction of stress.

Medications

  • To relieve minor itching, use non-prescription topical steroids or coal-tar preparations.
  • For severe itching, you may be prescribed:
    • More potent topical steroids.
    • Oral cortisone drugs (rarely, and for short periods only).
    • Antihistamines or mild tranquilizers.
    • Lubricating ointments for the hands.
    • Antibiotics (sometimes) to fight secondary infections.
Information Brand Generic Label Rating
Deltasone Prednisone
Imuran Azathioprine
Prograf Tacrolimus
Oral Antibiotics
Keflex Cephalexin
Ilosone Erythromycin
Oral Antihistamines
Zyrtec Cetirizine
Allegra Fexofenadine
Claritin Loratadine
Atarax Hydroxyzine
Corticosteroids
Decadron Dexamethasone
Medrol Methylprednisolone
Flonase Fluticasone topical

What might complicate it?

Due to decreased immunity, Staphylococcal, viral, and dermatophytic infections are common in atopic dermatitis. In severe cases, evolution into exfoliative erythroderma, and development of cataract may occur.

Predicted outcome

The outcome of atopic dermatitis is difficult to predict. Periods of remission and spontaneous resolution appear more frequently as an individual grows older. Late onset of disease correlates with more persistent disease.

Alternatives

Other possibilities are rare immunologic disorders and enzymatic deficiencies.

Appropriate specialists

Dermatologist, allergologist, and immunologist.

Notify your physician if

  • You or a family member has symptoms of atopic dermatitis.
  • You develop fever or uncontrolled itching during a flare-up.

Last updated 28 May 2012


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