A two-year-old with a very itchy, chronic rash is a pretty miserable fellow. His discomfort is enough to drive a parent to the nearest pediatrician’s office without delay. The diagnosis may be eczema, or more specifically, atopic dermatitis, a common disease estimated to afflict approximately 3 percent of Americans. Atopic dermatitis is a severe, chronic form of eczema, or skin inflammation, that typically affects very young children. Physicians, though, tend to use the terms “atopic dermatitis” and “eczema” interchangeably.
Symptoms of atopic dermatitis range from occasional itching to chronic, excruciating itching. Uncontrollable scratching and rubbing in severe cases can lead to infection-prone and potentially disfiguring skin rashes. These symptoms may wax and wane, but they persist over time.
Atopic dermatitis may have a significant impact on the quality of life for both child and family. Fortunately, most patients recover in early childhood. Only occasionally does the condition persist until age 25; rarely do patients suffer throughout their lives.
Atopic dermatitis is one of three so-called “atopic” allergic diseases. Asthma and hay fever are the others. The tendency to develop these conditions is clearly inherited: If one parent has a history of any of the atopic diseases, the child stands a 35 to 50 percent chance of developing one or more of them as well. If both parents have an atopic disease, the probability the child also will have one approaches 70 percent!
The itching, redness and swelling of atopic dermatitis is a result of inflammatory cells migrating into the skin. Because it may be difficult to stop this inflammatory reaction once it begins, the most effective means of control is to prevent or avoid initial “triggers”. These triggers differ from child to child. Here are some common factors that can trigger or aggravate atopic dermatitis:
- Dry Skin: Atopic dermatitis sufferers have a defect in their skin that prevents it from staying moist. Moist skin is soft and flexible; dry skin is scaly, rough, tight, and brittle. Dry skin also provides a less effective barrier against dirt, germs, and chemicals than moist skin does. In atopic dermatitis, it’s important to keep the skin well moisturized, especially in the winter when humidity is low. Perhaps the best way to do that is to preserve the skin’s natural moisturizers by avoiding excessive bathing, soaping, and washing, with hot water.
- Irritants: These are any substances outside the body that can cause burning, redness, itching, or dryness of the skin, including certain fabrics-wool, for example; cleaning products; and cosmetic ingredients. Identifying and avoiding irritants is critical.
- Stress: Just as stress can create headaches and stomach aches, it can also trigger atopic dermatitis. Unfortunately, having an itching, disfiguring skin condition is stressful in itself, and a vicious cycle can ensue. Identifying stress-inducing situations and finding ways to cope can help, however.
- Food Allergies: About 20 percent of children with atopic dermatitis experience increased itching, redness, and rashes after eating certain foods. Unfortunately, diagnosing food allergies is very difficult. The only definitive test is a “blind” food challenge, in which neither the patient nor the physician knows which food is being tested. Such challenges are time-consuming and difficult to interpret. Nevertheless, consult a board-certified allergist if you suspect food allergies. It’s not wise to eliminate all suspected foods from the diet. Doing so may result in serious malnutrition, especially in children.
- Pollen Allergies: Pollens may trigger atopic dermatitis in a few people. However most atopic dermatitis patients improve in the spring and summer when pollen counts are at their highest. Children with allergies to grass may experience flare-ups of skin problems after playing on a lawn. If such a reaction occurs, it generally improves when the pollen is washed off.
- Other Allergies: Other allergens, such as dust mites, mold and animal dander, are present throughout the year. They should be evaluated as possible atopic dermatitis triggers, and avoided if necessary. The common household dust mite feeds on sloughed-off human skin scales-and atopic dermatitis patients with dry skin provide an increased food source for this microscopic villain. Mold is often present in air conditioning systems. In people with allergies to animal dander, exposure to dogs, cats, or other fur-bearing pets may trigger atopic dermatitis.
- Sweating: Most people with atopic dermatitis itch more when they perspire or become overheated. Sweating occurs in any season, not just during humid summer months-after exercise, for example, and at night when too many bedclothes are used.
- Infections: Bacterial infections may be the most common and important triggers of atopic dermatitis. If the skin is weeping or crusting, or if small “pus bumps” occur, a bacterial infection is probably present. Atopic dermatitis sufferers are also prone to viral and fungal infections of the skin.
When all triggers cannot be avoided, these remedies can be helpful:
- Moisturizers: Creams and ointments such as Eucerin and Vaseline are best and should be applied to wet skin after bathing. Most lotions and oils are not rich enough and may even dry the skin of atopic dermatitis patients.
- Corticosteroids: Hydrocortisone creams and ointments are often the only treatment that effectively calms the inflamed skin of atopic dermatitis sufferers. While hydrocortisone can be quite safe, many of the more potent steroid creams can cause thinned skin, stretch marks, and other significant problems in children and adults. Parents should carefully monitor a child’s use.
- Antihistamines: These agents can be helpful in reducing itching, but may cause drowsiness.
- Tar preparations: Tar creams or bath emulsions may reduce mild inflammation.
- Antibiotics: Oral or topical antibiotics can reduce superficial bacterial infections that act as a trigger.
Atopic dermatitis can be maddening, but it can be managed. Early treatment by a trained allergy-immunology specialist or dermatologist may prevent long-term complications.