post-title Atopic Dermatitis (The Itch That Rashes) 2013-12-26 23:50:27 yes no Posted by

Atopic Dermatitis (The Itch That Rashes)

by Grace Ryu, MD Now that winter is upon us, the itch of eczema often rears its ugly head.  I have noticed cracked dry skin affecting my hands due to colder dry air and constant use of hand sanitizer between patients. 10-20% of children are affected by atopic dermatitis (eczema).  The majority develops this itchy rash […]

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by Grace Ryu, MD

Now that winter is upon us, the itch of eczema often rears its ugly head.  I have noticed cracked dry skin affecting my hands due to colder dry air and constant use of hand sanitizer between patients.

10-20% of children are affected by atopic dermatitis (eczema).  The majority develops this itchy rash before the age of 5. Adults unfortunately are not immune from developing eczema and it affects 1-3% of the adult population.  This is a genetically transmitted skin condition that is often chronic but can be controlled.  It is more often problematic during fall and winter due to decreasing humidity.  There can be other factors such as food, infections, emotions, sweating, inhalant allergies and stress that exacerbate eczema.  Many of my patients have multiple triggers.  Only a third of children have a food that triggers their eczema.

Treatment can be an overwhelming feat for parents due to the need for a multi pronged approach.

 

  1. Avoiding irritants is number one.  Cotton clothing and fragrance free soaps, shampoo, lotions, and detergents are a must.
  2. Hydration and moisturization to improve barrier function is next.  Daily baths are better for rehydration. Baths should be no longer than 10 minutes. There are different additives that can be added to the bath, such as bleach or salt.  Diluted bleach baths reduce the severity in patients with recurrent skin infections. Once done an occlusive moisturizer (thick cream not a lotion) should be applied liberally.  This will help diminish the itching.
  3. Topical steroids remain one of the most important treatments.  Yes moisturizing and proper bathing can control eczema but only in the mildest form.  Moderate to severe ezema require the use of topical steroids once the skin becomes red (inflamed).  Steroids come in different strengths and vehicles (ointment, creams, lotions, gels, foam).  There are risks with use, the most common are stretch marks or thinning of the skin, with prolonged use (greater than 2-3weeks) of high potency topical steroids.  Therefore high potency steroids should be used only for short periods and in nonfacial, nonskinfold areas.  Low- intermediate potency steroids, such as 0.1% triamcinolone can be used for longer periods of time.
  4. Topical nonsteroid creams are also a useful tool.  There are two prescription creams Elidel or Protopic.  They can be helpful in decreasing the need for topical steroid use.  Both are approved for age 2 and up.  Unlike topical steroids these do not cause stretch marks or thinning of the skin.
  5. Constant scratching/rubbing of the skin can worsen the itch. Antihistamines can be added at bedtime to help diminish the itch of eczema and keep nails short.
  6. Wet wrap therapy can be helpful by rehydrating the skin and calming the itch.  Ask your doctor about this therapy.
  7. Prick testing for possible triggers such as food or airborne allergens can be helpful.  Food allergy as a trigger for eczema is more common in children less than 5 years of age, but it is not a trigger in the majority of eczema patients.  Several studies have shown that reducing dust mite levels in the environment helped some patients.  Several studies also suggest that immunotherapy (allergy shots) in certain patients can be effective in the treatment of eczema.
  8. Antibiotic treatment maybe needed if the skin is infected by Staph aureus.   If chronic colonization by Staph aureus is an issue then consider bleach baths.

 

I have discussed the most common treatment/management recommendations but there are several for the difficult to manage patients that I omitted. It is always important to discuss with your doctor a treatment plan that is tailored for you or your child.

 

Grace Ryu, MD

 

 

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