Types of Eczema
Atopic Dermatitis

The most common type of eczema, atopic dermatitis is frequently described as “the itch that rashes.” Itching can become so intense that it diminishes a person’s quality of life. Children, who are most likely to develop atopic dermatitis, often cannot sleep through the night due to the intense itch.

Other Names

• Eczema (Atopic dermatitis is often called “eczema.”)

• Dermatitis

• Atopic eczema

This 7-year-old girl has atopic dermatitis on the backs of her knees — a common area for the patches to appear.		In infants, atopic dermatitis often develops on the face.
		About 50% of people who develop atopic dermatitis during childhood continue to experience signs and symptoms — usually less severe — as an adult.
(Photos used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides)

Signs and Symptoms

• Extremely itchy patches of skin.
  
  In infants, these patches tend to develop on the scalp and face, especially on the cheeks. Teens and young adults are more likely to see patches on their hands and feet. Other common sites for these patches are the bends of the elbows, backs of knees, ankles, wrists, face, neck, and upper chest. The patches may not always appear in these areas; they can occur anywhere on the skin, including around the eyes and on the eyelids.
   

• Redness, swelling, cracking, the “weeping” of clear fluid, crusting, and scaling.
   

• Patches may bubble up and ooze or be scaly, dry, and red.
   

• Without proper treatment, the skin thickens to protect itself from further damage caused by scratching. Dermatologists call this thickening of the skin “lichenification.”

Who Gets

• Approximately 10% to 20% of the world’s population develops atopic dermatitis.
   

• An estimated 65% develop atopic dermatitis during their first year of life, and 90% develop the condition before age 5. While rare, atopic dermatitis can begin at puberty or later.
   

• While atopic dermatitis resolves in many children by age 2, 50% continue to experience signs and symptoms into adulthood — usually as hand eczema.
   

• Occurs in all races and skin types. Studies show no strong racial differences.

Causes
While the cause of atopic dermatitis is not fully understood, researchers believe a complex interaction of several factors — the genes we inherit, where we live, a breakdown of the outermost layer of skin, and a malfunctioning immune system — leads to atopic dermatitis.

Risk Factors
The following appear to increase one’s risk:

• Family history. A family history of atopic (tendency for excess inflammation in the skin, linings of the nose, and lungs) conditions, such as atopic dermatitis, asthma, or hay fever. This remains the strongest risk factor. If one or both parents have a history of atopic dermatitis or an allergic condition, the child is much more likely to develop atopic dermatitis.
   

• Where person lives. Living in a developed country, urban area (especially one with higher levels of pollution), or northerly part of the world seems to increase the risk. For example, Jamaican children living in London are twice as likely to develop atopic dermatitis as are Jamaican children living in Jamaica.
   

• Age. Appears before 1 year of age in 65% of people; 90% develop before reaching 5 years of age.
   

• Gender. Females are slightly more likely than males to develop.
   

• Mother’s age at time child born. Atopic dermatitis tends to be more common when the mother gives birth to a child later in her childbearing years.
   

• Year born. During the last 40 years, a steadily increasing number of people worldwide, mostly children, have developed atopic dermatitis. In the United States alone, the prevalence of atopic dermatitis in children born after 1980 has increased by 15% to 20%. This equals a 3- to 4-fold increase over the 5% prevalence rate reported during the 1950s in school-age children.
   

• Social class. Atopic dermatitis tends to be more common in higher social classes.
   

• Family size. Atopic dermatitis tends to be more common in immediate families that are smaller in size.

Duration

• Several studies suggest that when atopic dermatitis develops in an infant or young child, the child tends to get better with time. For some children, the condition completely resolves by age 2 without treatment.
   

• Atopic dermatitis also can be a lifelong condition. About 50% of people who develop atopic dermatitis as children have it for life. It tends to become less severe with age.

How Diagnosed

• Dermatologists look for signs that the skin itches as well as rashes. They ask about the patient’s medical history and the medical history of close blood relatives to learn if there is a history of atopic dermatitis, asthma, or hay fever.
   

• Patch testing, a medical test used to find allergies, may be conducted to learn if the patient has allergic contact dermatitis (another common type of eczema).

Treatment

• While atopic dermatitis cannot be cured, most cases can be controlled with proper treatment. The goals of treatment are to hydrate the skin, reduce inflammation, decrease the risk of infection, and alleviate the itchy rash.
   

• Signs and symptoms may be treated with:

  • Emollients to help relieve dry skin

  • Cold compresses applied directly to the skin to help relieve the itch

  • Corticosteroids to help reduce inflammation; topical tacrolimus and pimecrolimus also may be used to reduce inflammation

  • Antibiotics to treat a bacterial infection

  • Sedative antihistamines to help the patient get a good night’s sleep

  • Phototherapy can help relieve moderate to severe cases
     

• Effective treatment often requires a multifaceted treatment plan that includes medication, proper skin care, trigger avoidance, and coping mechanisms. While doing all of this may seem bothersome, adhering to a treatment plan can help the patient feel better and stop the atopic dermatitis from getting worse.
   

• Despite the advertised claims, studies have not shown the following food supplements to be helpful — evening primrose oil, borage oil, zinc, B6 (pyridoxine), and vitamin E.
   

• While atopic dermatitis may resolve without treatment in children, this does not tend to occur in adults.

References:
Abramovits W. “Atopic Dermatitis.” Journal of the American Academy of Dermatology. 2005; July;53(suppl #1):S86-S93.

American Academy of Dermatology, “Eczema/Atopic Dermatitis.” (pamphlet).

The Lewin Group (prepared for the Society for Investigative Dermatology and the American Academy of Dermatology Association). “The Burden of Skin Diseases.” 2004. p.40-44.

Peters J. “Eczema.” Nursing Standard. 2000; January;14(16):49-55.

Simpson EL et al. “Atopic Dermatitis.” Journal of the American Academy of Dermatology. 2005; July;53(1):115-128.

Williams HC. “Atopic Dermatitis.” New England Journal of Medicine. 2005. June;352(22):2314-2324.
 

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