Atopic dermatitis facts
- Atopic dermatitis is a type of eczema.
- The disease may be inherited and genetically determined.
- The patient's skin may be "super sensitive" to many irritants.
- Dry, scaly patches develop in a characteristic distribution.
- Itching varies but may be intense and scratching hard to resist.
- Scratching can cause skin thickening and darkening and lead to further complications, including bacterial infection.
- Extremely dry skin can break down and ooze or weep.
- If the itch can be controlled, the rash (which is aggravated by vigorous scratching) may be more readily treated.
- Treatment of atopic dermatitis is centered around rehydrating the skin with emollients like petroleum jelly and cautiously using topical steroids to reduce inflammation and itching.
- Oral antihistamines may be helpful in breaking the "itch-scratch" cycle.
- Since secondary infections can aggravate the rash, topical or oral antibiotics may also be occasionally indicated.
What is atopic dermatitis?
Atopic dermatitis is a common, often long-lasting skin disease that affects a large percentage of the world's population. It is a special type of hypersensitivity that includes asthma, inhalant allergies (hay fever), and a chronic dermatitis (eczema). There is a known hereditary component of the disease, and it is more common in affected families. Criteria that enable your doctor to diagnose it include the typical appearance and distribution of the rash in a patient with a personal or family history of asthma and/or hay fever.
The term atopic is from the Greek meaning "strange." The term dermatitis means inflammation of the skin.
In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, vesicle formation (minute blisters), cracking, weeping, crusting, and scaling. This type of eruption is termed eczematous. In addition, dry skin is a very common complaint in almost all those afflicted with atopic dermatitis.
Although atopic dermatitis can occur in any age, most often it affects infants and young children. Occasionally, it may persist into adulthood or may actually appear at that time. Some patients tend to have a protracted course with various ups and downs. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, which are followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis enter into a permanent remission of the disease when they get older, although their skin may remain somewhat dry and easily irritated.
Multiple factors can trigger or worsen atopic dermatitis, including low humidity, seasonal allergies, exposure to harsh soaps and detergents, and cold weather. Environmental factors can activate symptoms of atopic dermatitis at any time in the lives of individuals who have inherited the atopic disease trait.
What is the difference between atopic dermatitis and eczema?
Eczema is a nonspecific term for many types of skin inflammation (dermatitis). There are different categories of eczema, which include allergic, contact, irritant, and nummular eczema, which can be difficult to distinguish from atopic dermatitis. These types of eczema are listed and briefly described below. Atopy is a medical syndrome that includes three associated conditions that tend to occur in the same individual: atopic dermatitis, inhalant allergies, and asthma. All three components need not be present in the same individual simultaneously.
Types of eczema
- Contact eczema: a localized reaction that includes redness, itching, and burning where the skin has come into direct contact with an irritant such as an acid, a cleaning agent, or other chemical.
- Allergic contact eczema: a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions like Neosporin or bacitracin (Baciguent)
- Seborrheic eczema (also called seborrheic dermatitis or seborrhea) is a very common form of mild skin inflammation of unknown cause that presents as yellowish, oily, scaly patches of skin on the scalp, face, ears, and occasionally other parts of the body. Often this is also called dandruff in adults or "cradle cap" in infants.
- Nummular eczema: coin-shaped (round), isolated patches of irritated skin -- most commonly on the arms and lower legs -- that may be crusted, scaling, and extremely itchy
- Lichen simplex chronicus (localized neurodermatitis): a dermatitis localized to a particular anatomical area induced by long-term rubbing, scratching, or picking the skin. The underling cause may be a sensitivity or irritation that sets off a cascade of repeated itching and scratching cycles. It may be seen as scratch marks and pick marks. Areas of thickened plaques form on the skin of the neck, shins, wrists, or forearms. This condition has certain similarities to calluses, and it will resolve if the patient stops irritating the area.
- Stasis dermatitis: a skin irritation on the lower legs, generally related to circulatory problems and congestion of the leg veins. It may have a darker pigmentation, light-brown, or purplish-red discoloration from the congestion and back up of the blood in the leg veins. It's sometimes seen more in legs with varicose veins.
- Dyshidrotic eczema: irritation of the skin on the palms of hands (mostly) and less commonly soles of the feet characterized by clear, very deep-seated blisters that itch and burn. It's sometimes described as a "tapioca pudding"-like rash on the palms.
- Xerotic eczema: areas of very dry skin most often seen on the lower legs of the elderly