Atopic Dermatitis: An Overview
REBECCA BERKE, MD ARSHDEEP SINGH, MD and MARK GURALNICK, MD, Kaiser Permanentes Woodland Hills Family Medicine Residency Program, Woodland Hills, California
Am Fam Physician. 2012 Jul 1 86:35-42.
Patient information: See related handout on eczema, written by the authors of this article.
Atopic dermatitis, also known as atopic eczema, is a chronic inflammatory skin condition characterized by pruritic, erythematous, and scaly skin lesions often localized to the flexural surfaces of the body . It can present with asthma and allergic rhinitis as part of an allergic triad an estimated 30 percent of children with atopic dermatitis develop asthma later in life.1 The onset of atopic dermatitis generally is before two years of age, with only 10 percent of cases diagnosed after five years of age.2 A 2003 survey of children in the United States estimated an overall prevalence of approximately 11 percent, and as high as 19 percent in some states.3 A 2007 U.S. population-based survey suggested an estimated 17.8 million persons are living with atopic dermatitis, and most cases have not been diagnosed.4 Early diagnosis and treatment may prevent significant morbidity from sleep disturbances, chronic postinflammatory skin changes, scarring from picking and scratching, and the development of secondary skin infections with Staphylococcus, Streptococcus, and herpes species.5
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Emollients are a mainstay of therapy for atopic dermatitis.
Treatment Of Severe Eczema
Patients with severe eczema or those that do not respond to first-line therapy should be referred to a dermatologist for evaluation and treatment. Second-line therapies used in refractory eczema are shown in the table below.
|Treatment of refractory eczema|
Vanicream Moisturizing Skin Cream $1356
As one of Dr. Chans favorites for those with allergies especially, Vanicreams Moisturizing Cream comes in an easy-to-use pump, is fragrance-free and is non-comedogenic, so it wont clog your pores.
The lotion formulation makes this product cosmetically elegant for the face, while still being effective to minimize eczema flares, Dr. Mack said.
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Do Moisturizers Help Eczema
Moisturizers are the first-line therapy in treating eczema. They help protect the outer layer of the skin by sealing in moisture, combating dryness, keeping out allergens, irritants and bacteria and preventing flare-ups. And they soothe the skin for long-lasting hydration.
Doctors recommend you apply a moisturizer at least twice per day, including once after a bath or shower. Develop a schedule so that moisturizing becomes part of your skincare routine.
If you experience symptoms on your hands, keep moisturizer by all sinks in the home or carry a small tube with you. This way you can easily moisturize every time you wash your hands throughout the day.
Important Update To The Medication Guide For Rinvoq Extended
On January 14, 2022, the RINVOQ Prescribing Information and Medication Guide for RINVOQ was updated to include new information about allergic reactions.
The following serious side effect was added to the section What is the most important information I should know about RINVOQ?
RINVOQ may cause serious side effects, including:
Do not take RINVOQ if you are allergic to upadacitinib or any of the ingredients in RINVOQ. See the end of the Medication Guide for a complete list of ingredients found here.
On December 2, 2021, the RINVOQ Prescribing Information and Medication Guide were updated to include new information about the increased risk of death and serious heart-related events, such as heart attack or stroke, and updated information about the risk of cancer and blood clots based on discussions with the FDA.
RINVOQ may cause serious side effects, including:
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Best For Dry Skin: Cln Bodywash
Courtesy of Amazon
For use in treatment of eczema, folliculitis, and acne
Safe for anyone 6 months and older
Cleanses without disrupting skin barrier
Some users reported breakouts or rashes after use
More costly than other eczema soaps
CLns BodyWash is designed to reduce redness, dryness, and flakiness. It’s a cleanser that is safe for daily use, preserved with sodium hypochlorite for a strong but calming sensation for your eczema. This body wash does not contain any parabens, steroids, or fragrances, so it’s a great choice for both adults and children.
This product is recommended by the National Eczema Association.
Key Ingredients: Sodium hypochlorite | How to Use: Wet skin and pump small amount of soap into hands lather, massage into skin, rinse, and dry.
What Ingredients Are Best To Help Treat Eczema
Eczema is a clinical dysfunction of the skin barrier, Dr. Libby notes. As such, genetic, environmental, and immunologic factors contribute to its flare-up, but its a priority to repair the skin barrier. Namely, ingredients to help reverse eczematic effects are humectants, emollients and occlusive moisturizers.
According to Dr. Libby, humectants help add moisture back to the skin, while emollients add back oils, lubricating and softening the skin. Occlusive moisturizers work to prevent transepidermal water loss .
Common humectants are glycerin, lactic acid, urea and hyaluronic acid, Dr. Libby adds. Emollients examples are glycol and glyceryl stearate, soy sterols, squalane, and oils like jojoba, sweet almond, etc. Common occlusives are petrolatum, dimethicone, shea butter and mineral oil.
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How Do Dermatologists Diagnose Dyshidrotic Eczema
If your dermatologist suspects that you have dyshidrotic eczema, your dermatologist will:
Look closely at the skin on your hands and feet
Take a bit of fluid from a blister if it looks infected
Ask you questions about your health, what you do for work and hobbies, and when you usually develop blisters
During your appointment, be sure to tell your dermatologist if you have a metal implant in your body or recently:
Noticed that your skin reacts when you wear certain jewelry
Worked with cutting oil or cement
Took a medication, including aspirin or birth control pills
If your dermatologist thinks that the dyshidrotic eczema could be due to an allergy, an allergy test called patch testing may be recommended. During patch testing, small amounts of substances that you may be allergic to are placed on your skin often the skin on your back.
Thats often all thats needed to determine whether you have dyshidrotic eczema. If you do, your dermatologist will create a treatment plan tailored to your needs.
Having an infection can stop dyshidrotic eczema from clearing
In one study, researchers found that about 33% of patients who had dyshidrotic eczema on their hands got rid of the dyshidrotic eczema only after treating an infection on their feet.
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Dr. Chan recommends Avenes XeraCalm A.D. Lipid-Replenishing Balm as one of her favorite eczema creams. Why? It nourishes that itchy feeling, helps rebalance the skins microbiome and seals in moisture for up to 48 hours.
It helps calm dry, irritated and sensitive skin by helping to reduce itching, and alleviating redness and inflammation, Dr. Libby notes, too, as one of her favorite eczema creams.
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What Are The Signs And Symptoms Of Eczema
Eczema can affect any area of the skin.
The severity of symptoms and areas affected can vary.
Itching is the most significant symptom of eczema, and scratching makes it worse. The itching is often bad enough to disturb sleep. Sometimes the scratching can be so severe that areas of skin start to bleed. They may also become infected so that the skin oozes and crusts. If inadequately treated patches of eczema may become thickened and discoloured.
Antihistamines And Pain Relievers
Atopic dermatitis , the most common form of eczema is part of whats known as the atopic triad . In fact, people with AD have a greater chance of developing comorbidities or related health conditions, namely asthma, hay fever and food allergies. To help combat itch and curb inflammation if you have allergies, a healthcare provider may suggest antihistamines. Some antihistamines also contain sedatives that can help people sleep.
Examples of OTC oral antihistamines include:
To address common eczema symptoms such as burning, pain and inflammation, a healthcare provider may also suggest OTC pain relievers such as:
- Nonsteroidal anti-inflammatory drugs including ibuprofen
Recommended Reading: Texas Children’s Dermatology Eczema
How To Use Emollients
Use your emollient all the time, even if you’re not experiencing symptoms.
Many people find it helpful to keep separate supplies of emollients at work or school, or a tub in the bathroom and one in a living area.
To apply the emollient:
- use a large amount
- do not rub it in smooth it into the skin in the same direction the hair grows
- after a bath or shower, gently pat the skin dry and apply the emollient while the skin is still moist to keep the moisture in
You should use an emollient at least twice a day if you can, or more often if you have very dry skin.
During a flare-up, apply generous amounts of emollient more frequently, but remember to treat inflamed skin with a topical corticosteroid as emollients used on their own are not enough to control it.
Do not put your fingers into an emollient pot use a spoon or pump dispenser instead, as this reduces the risk of infection. And never share your emollient with other people.
How To Choose The Best Eczema Cream For You
Ready to shop until your eczema flare-ups drop? Here are some tips for finding the best cream for your needs.
- Check the ingredient list twice. Some products may look tempting and nearly eczema-approved, but its best to avoid ingredients like alcohol, parabens, urea, and fragrance, just in case.
- Try a trial size. Try to purchase the smallest size of a product to test it out before you commit to your forever cream . Many derms offer sample sizes of both prescription and over-the-counter lotions, so consider heading to your doc.
- Dont assume more $ = better. Thankfully, when it comes to eczema creams, theres something with legit ingredients at every price point. You really dont need to splurge to secure an effective product, and whats more expensive wont necessarily work better for your unique needs.
- Consult the pros. You might want to look up products in the National Eczema Association directory to see if theyve received a Seal of Acceptance. The association considers these products legit for those with eczema or sensitive skin based on a variety of criteria. Products have to apply for the label, though, so some quality products might not have the seal, but it may help you narrow down your search.
Still not sure where to turn? As Graf explains, the reality is that everyones treatments are unique based on the severity. If your symptoms get worse or dont go away, she always advises seeing a dermatologist for treatment.
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Balancing The Skins Acidity Levels
Vinegar is highly acidic. The skin is naturally acidic, but people with eczema may have less acidic skin than others, which can weaken the skins defenses.
Applying diluted apple cider vinegar could help balance the skins acidity levels, but vinegar can cause burns if it is not diluted.
In contrast, many soaps, detergents, and cleansers are alkaline. They can disrupt the acidity of the skin, which can leave the skin vulnerable to damage. This may explain why washing with certain soaps can cause eczema flares.
Bacterial Treatments For Eczema
While scientists still dont know exactly what causes atopic dermatitis, they have been exploring the role that the microbiome may play in the disease. People with eczema have unusually high amounts of harmful bacteria on their skin and lower than normal levels of good bacteria.
A potential new approach to treating eczema involves using good bacteria to kill pathogenic bacteria like Staphylococcus aureus, which is commonly found in large quantities on the skin of people with eczema and is known to cause symptom flare-ups. Though such treatments are not yet available to the public, preliminary research is encouraging.
An early study published in JCI Insight found that more than half of a small group of adults treated with Roseomonas mucosa in a spray form experienced improvement in their eczema, with some reporting that they needed less steroid cream to manage their symptoms.
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Best Alternatives To Eczema Lotions
Dermatologists often prescribe ointments as a first-line eczema treatment. Ointments seal in moisture and have a higher oil content than creams and lotions. However, some people dislike the feeling of an ointment. An ointment may also stain clothing.
Another alternative to an ointment is a cream. Creams have a lower oil content than ointments but still contain more oil than lotions. They help trap moisture in the skin but are less greasy than ointments.
What Can I Expect If Ive Been Diagnosed With Eczema
Nearly half of children with eczema will outgrow the condition or experience great improvement by the time they reach puberty. Others will continue to have some form of the disease. For adults with eczema, the disease can be generally well-managed with good skin care and treatment, although flare-ups of symptoms can occur throughout life.
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Food Allergy And Eczema Flare
- Food allergies are a factor in 30% of young children with severe eczema. This factor is mainly seen in babies.
- The main allergic foods are cow’s milk and eggs.
- The main symptoms are increased skin redness and itching. Some parents report these symptoms start during or soon after the feeding.
- The eczema becomes easier to control if you avoid the allergic food.
Other Treatments Effective And Ineffective In Atopic Dermatitis
Probiotics have recommended as a therapeutic option for the treatment of AD. The rationale for their use is that bacterial products may induce an immune response of the Th 1 series instead of Th 2 and could therefore inhibit the development of allergic IgE antibody production. Some report limited benefit in preventive and therapeutic roles. A meta-analysis of 25 randomized placebo-controlled controlled trials involving 4031 subjects found that prenatal and postnatal administration of probiotics reduced IgE levels in infants and that it may protect against sensitization to hereditary allergies but may not protect against asthma or wheezing. In January 2015, the World Allergy Organization recommend the use of probiotics by pregnant and lactating women and their breastfed infants to prevent the development of AD. The recommendation was based on a meta-analysis of 29 studies in which probiotic use by pregnant women reduced the incidence of eczema by 9% during a 1- to 5-year follow-up period and use by lactating women was associated with a 16% reduction in eczema during a 6-month follow-up period. Probiotic consumption by breastfeeding infants was associated with a 5% reduction in eczema during the 6-month to 6-year follow-up period.
UV-A, UV-B, a combination of both, psoralen plus UV-A , or UV-B1 therapy may be used. Long-term adverse effects of skin malignancies in fair-skinned individuals should be weighed against the benefits.
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Lotions Creams And Ointments
Ointments have the most oil. Theyâre usually the best choice to treat eczema. They won’t burn when you apply them to your skin. They help it hold on to moisture.
Some people like to use them overnight. This gives your skin time to absorb them fully. Petroleum jelly and mineral oil are examples.
Creams are a good choice if you don’t like the greasy feel of an ointment. They have the second highest amount of oil. They can also seal in moisture.
Be sure to read labels carefully. Creams often contain additives that can irritate your skin or cause allergic reactions in some people.
Lotions are mostly made of water and have the lowest amount of oil. They don’t usually work well for people with eczema. They evaporate quickly and may have ingredients that bother your skin.
How Is Eczema Diagnosed
As eczema is such a common condition, it can almost always be diagnosed by your family doctor or health visitor. They may ask about when the symptoms appeared, how long they have been present and how they are affecting the childs everyday life. They will also look at the childs skin to map which areas are affected. If any patches seem to be infected, they may take a skin swab to send to the laboratory for testing. This is needed to identify the bug causing the infection.
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Sarah is a freelance writer with a focus on health and wellness. She has written for publications like Women’s Health, Healthline, and Parents. She taught creative writing for five years, and has a bachelor’s degree in English from Southern Connecticut State University.
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One in 10 people will experience eczema at some point in their life. Atopic dermatitis, or eczema, is a condition caused by a defect in the barrier of the skin in combination with inflammation in the skin,” explains Charlotte Birnbaum, MD, FAAD, at Spring Street Dermatology in New York City. “Because the barrier is defective in eczema, the skin is more sensitive to allergens and irritants. That’s where soaps for eczema come in.