Clive Anderson - AT THE DERMATOLOGIST WHAT IS atopic dermatitis (eczema)? It is a very common skin condition that seems to run in families where asthma, hay fever, and some allergies are found.
What does it look like? Atopic dermatitis is characterised by dry, scaling, itchy patches of skin. In infants and small children, it typically involves the face and scalp, but may be more extensive covering all areas but the diaper area. Adults and teenagers most commonly experience dryness and thickening on the hands, neck and chest, inner elbows, back of the knees and the ankles. The itching is so intense that many patients, especially children, scratch or rub themselves until they bleed.
What causes it? No one knows what causes it. It is probably best to think of it as very sensitive skin that gets itchy from contact with lots of things. People with atopic dermatitis feel itchy easier than other people. Many things can trigger itching or make it worse. Scratching damages the skin and makes the itching worse. The skin tries to protect itself by thickening, but this just makes the skin drier and itchier.
Can it be cured? Most people with atopic dermatitis will have good weeks and bad weeks. They may get worse in the summer when it is hot and they sweat or in the colder months. Some children grow out of it by the time they start school but others continue to have occasional bad spells even as an adult.
Is it infectious? No. You can't catch it from someone or give it to someone by touching him or her. It is not infectious, but it can become infected. Antibiotics may be helpful if your dermatologist thinks it has become infected.
Does it turn into cancer? No. It doesn't cause skin cancer and isn't
dangerous.
Does stress cause it? Stress doesn't cause atopic dermatitis. However, if a person with atopic dermatitis is in a stressful job or home situation, it may make the itching worse.
Are there any jobs patients should avoid? Yes, any job that involves work with harsh detergents, irritating solutions, dusty areas (like nursing, nurses' aides, auto mechanics, hairdressing, some factory work).
What can I expect from treatments? The goal of treatment is to keep you or your child with atopic dermatitis comfortable. Atopic dermatitis can be very difficult and frustrating to treat as recurrences are common.
How often should baths be taken? Most patients with atopic dermatitis do better if they take a nice, long, cool bath or shower once or twice every day as long as they rub on a moisturising cream as soon as the bath is over and while the skin is still wet. Rubbing the cream onto the wet skin will trap moisture in the skin. Only a thin layer of cream is needed to trap the moisture in the skin.
Use unscented neutral soaps. Avoid perfumed soaps and deodorant soaps. When you get out of the tub or shower, pat dripping water from the skin. You have three minutes to apply any prescription ointment to the bad spots and then get the moisturiser on.
HOW IS IT TREATED?
1. Use only the creams or ointments your doctor orders or recommends for you. Don't use moisturisers that are perfumed or scented. These and many other creams and lotions have preservatives which may make the itching worse.
2. Try to stop scratching. Scratching makes the problem worse. Instead of scratching, wet skin with a cool cloth or ice cube and gently rub some cream on the itch. If the itch happens when you can't do any of the above things, try patting the itchy spot once or twice, or rub it gently, or even pinch it gently.
3. Steroid creams or ointments are commonly used to treat areas of eczema. Stronger steroid creams may cause thinning of the skin or an acne-like rash if used in the same area for many weeks. Only the weakest creams should be used on the face. As the skin begins to improve switch to lower strength creams or just moisturising creams. A new non-steroidal treatment called Elidel may be useful for long-term treatment without the steroid side effects.
Dr. Clive Anderson is a Dermatologist and Venereologist.
