ECZEMA (ATOPIC DERMATITIS)

Definition:

Eczema (also referred to as “atopic dermatitis”) is a long-term inflammatory condition of the skin. Though the exact cause of the disorder is unknown, a few abnormal genes may play a role, which makes it more likely to run in some families.  It is also associated with two other allergic disorders, asthma and allergic rhinitis (“hay fever”), which together is termed the “atopic triad.”  The condition usually begins in early childhood and can wax and wane throughout life.

Symptoms:

1. Generalized dryness of the skin
2. Frequent itching, usually worse at night
3. Patches of redness, flaking, and scaling
4. Occasional small blisters filled with clear fluid
5. Areas of thickened, dark, and wrinkled skin
6. Open sores over severely affected plaques

Distribution:  Though eczema can affect any part of the body, it usually is more prevalent in certain areas in different age groups as stated below:

1. Infants:  Scalp, face (especially over the cheeks and around the eyes), and neck
2. Older children and adults:  Chest and back, inside the bends of elbows and knees, around the wrists and ankles, and on the tops of the hands and feet

Aggravating Factors and Complications:

1. Changes in heat and humidity
2. Long, hot showers/baths resulting in excessive dryness of the skin
3. Irritants like strong soaps, detergents, and other chemicals
4. Exposure to dust, pollen, and other allergens
5. Ingestion of foods that one is sensitive to, or allergic
6. Excessive sweating and emotional stress
7. Loss of protective skin barrier function due to scratching and sores
8. Infections with bacteria, especially Staph.

Diagnosis and Tests:

Diagnosis is usually made by thorough history and physical examination. Occasionally prick skin tests and/or patch tests are needed to identify the compounding factors.

Treatments:

1. Hydration of the skin with daily liberal application of moisturizing lotions and creams all over the body.  They are best applied immediately after showering or bathing when the skin is still damp to seal in the moisture.
2. Avoidance of irritating chemicals like strong soaps, detergents, and cosmetics.
3. Using humidifiers to reduce exposure to dry, hot indoor air during the winter.
4. Environmental controls to reduce exposure to dust mites, molds, and other allergens.
5. Identification and avoidance of foods which can aggravate rash and itching.
6. Oral antihistamines to break the itch-scratch cycle.
7. Topical steroid and non-steroidal creams and ointments to control inflammation.
8. Topical calcineurin inhibitor creams and ointments to control inflammation.

As steroid medications can cause side effects like thinning of the skin, discoloration, and susceptibility to infections, the lowest effective potency preparations should be used, preferably up to 10 days at a time.  In spite of good care and treatments, the condition can at times lead to severe flare-ups causing considerable frustration and distress.  The management of stress and contact with support groups can be very helpful.

The board certified allergists and staff at Black and Kletz Allergy have accumulated enormous experience and expertise in treating thousands of patients with eczema over several decades in the Washington DC, Northern Virginia, and Maryland metropolitan area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.