What is atopic dermatitis?

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There is quite a variation in the appearance of atopic dermatitis between individuals. From time to time, most people have acute flares with inflamed, red, sometimes blistered and weepy patches. In between flares, the skin may appear normal or suffer from chronic eczema with dry, thickened and itchy areas. The cause of atopic dermatitis is poorly understood and is the subject of active research. Research shows that it develops as a result of interaction between the environment, your immune system, and genetics (heredity). People with this condition seem to have very sensitive immune systems that are more prone to react to irritants and allergens.

Most people who have atopic dermatitis have a personal or family history of allergic conditions, such as hay fever (allergic rhinitis). The skin inflammation that causes the atopic dermatitis rash is considered a type of allergic response. The presence of infection or an additional skin condition, the creams applied, the age of the person, their ethnic origin and other factors can alter the way eczema looks and feels. There are however some general patterns to where the eczema is found on the body according to the age of the affected person.

Atopic dermatitis leads to itching and redness, and may make the skin dry and flaky. Sometimes itchy blisters form. The surface of the skin may become moist and crusty if these blisters burst, or when scratching damages the skin. Atopic dermatitis is often worse in the folds of the skin where the limbs bend. The itch is intense, but scratching only makes the symptoms worse. Dermatitis makes the skin more sensitive, so you may notice that you are more irritated by cosmetics, soaps, detergents, etc. Atopic dermatitis in infants is most commonly seen on the face, scalp, and diaper area. It can also appear on the limbs and feet. Atopic dermatitis is usually diagnosed through a physical examination. If in doubt, or your doctor feels that you need further tests, you may be referred to a skin specialist, called a dermatologist. Further tests may include skin biopsy, in which a small sample of the inflamed skin is removed for testing, or patch tests, in which little patches of different substances are stuck to your skin for a few days to see if you react to any of them.

There is essentially no cure for atopic dermatitis because it involves a sensitivity of the skin that will always remain to some degree. There are, however, a number of approaches that help to minimize symptoms. The primary treatment is to keep the skin moisturized using creams, ointments, and shower and bath oils that help to replenish the skin's natural protective oils. Your doctor may also prescribe a cream or ointment containing a steroid. These are very effective at reducing inflammation and itch. Your doctor will want you to use this sparingly, and only while the dermatitis is at its worst. There are different strengths of steroid applications, and the tendency is to use the lowest strength that the skin requires at the time in order to minimize the risk of possible side effects. Oral antihistamines may also be helpful in reducing the itch. Your doctor will prescribe antibiotics if the skin becomes infected, which it is more likely to occur when the skin’s normal protective surface has been damaged. If your skin does not improve, additional treatments might include bandages and wet wraps, and drugs to suppress the immune system. Phototherapy, which is ultraviolet light treatment (UVB and PUVA), can also be used to treat atopic dermatitis.

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