What is Eczema (Atopic Dermatitis)?

Atopy is the tendency, which is usually genetically determined, to react adversely on exposure to certain things that our immune system considers as foreign and potentially harmful.  Atopic dermatitis is an inflammatory disorder affecting the skin, usually beginning in early childhood.

Children are more likely to develop skin inflammation if their parents and/or siblings also have this condition, as it “runs in families.”  The face and extensor surfaces of the limbs are the most commonly affected parts of the body in infants, whereas in older children, the flexural areas of the elbows, knees, armpits, and neck are more commonly involved.  It is important to note however that the skin on any part of the body can become inflamed and affected.

The appearance of skin involved in atopic dermatitis is quite characteristic.  There is generalized dryness of skin and certain areas manifest “eczematous” changes which present as patches of lichenification (i.e., thick and coarse skin with accentuated creases).  More severe involvement can lead to redness, scaling, and/or cracking of the skin leading to raw and sore areas.  The condition is also usually associated with intense itching (i.e., pruritus).

The severity of the condition varies widely ranging from mild generalized dryness to extreme disfigurement adversely affecting one’s quality of life.  In the affected individual, the severity also varies from time to time leading to periods of remissions and exacerbations commonly referred to as flare-ups.

These flare-ups of the condition can be triggered by weather changes.  In the summer, the extreme heat may cause excessive sweating which can trigger an exacerbation of atopic dermatitis.  Likewise, the winter’s cold dry air is often a factor that will cause a flare-up in many individuals.  Many studies also demonstrate that exposure to foods that one is sensitized to (especially dairy, eggs, wheat, soy, peanut, and tree nuts) can trigger or aggravate atopic dermatitis.  Environmental allergens such as dust mites and pet dander may also be detrimental to many individuals with atopic dermatitis.

The atopic dermatitis condition itself also reduces the barrier function of the skin making it more susceptible to colonization with microbes like Staphylococcus bacteria.  Secondary skin infections with Staphylococcus can further increase the severity and make the condition more recalcitrant.

Management:

1. Hydration of the skin with a daily application of a moisturizing lotion (i.e., emollients) all over the body immediately after a shower or a bath will reduce the propensity for flare-ups. Generally the drier the skin is, the itchier it is.
2. Avoidance of exposure to known triggers of the condition such as the consumption of foods one is sensitized to as determined by skin and/or blood tests.
3. Certain oral antihistamines, especially the first generation ones, are helpful in relieving the bothersome itching and breaking the vicious itch-scratch cycle.
4. Topical anti-inflammatory medications, preferably in the form of ointments, are very helpful in controlling the flare-ups.  Corticosteroids of varying potency are the most commonly employed topical agents, but their potential side effects limit their long-term use.  Non-steroidal topical medications such as Protopic (i.e., tacrolimus), Elidel (i.e., pimecrolimus) and more recently approved Eucrisa (i.e., crisaborole) are also very helpful to control chronic inflammation.
5. Phototherapy, sitz baths, and cold compresses are also employed depending on the severity of the condition.
6. Very recently, a biological injectable monoclonal antibody medication called Dupixent (i.e., dupilumab) was approved for the treatment of moderate to severe atopic dermatitis.  It is given subcutaneously at a first time dose of 600 mg. followed by a dose of 300 mg. every 2 weeks to adults 18 years of age and older.

When a secondary staphylococcal or other bacterial infection is suspected, antibiotics are prescribed either to eradicate or lessen the burden of bacterial colonization.

Eczema or atopic dermatitis is a very common skin condition.  Individuals with the propensity for allergies are more likely to have this malady.  The board certified allergists at Black & Kletz Allergy treat both children and adults with eczema and are very knowledgeable in the diagnosis and treatment of eczema.  We have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Please call us to schedule an appointment if you or your child suffers from eczema.