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Atopic Eczema

What is Atopic Eczema/Dermatitis?

Atopic eczema is a very common skin condition. It is an itchy, chronic or chronically relapsing, inflammatory skin condition. The rash is characterized by itchy papules (occasionally vesicles in infants), which become excoriated and thickened. The term “eczema” is used interchangeably with “dermatitis” and refers to inflammation of the skin. Atopic eczema is also known as Atopic Dermatitis. The eruption is frequently associated with other atopic conditions in the individual or other family members such as bronchial asthma, allergic rhinitis, allergic conjunctivitis or hay fever, due to a genetic predisposition.

It is not an infectious disease. One would not develop atopic eczema by touching a kid or an adult known to have atopic eczema.

How does Atopic Eczema present?

Atopic eczema commonly presents in infancy and childhood, but can also occur for the first time in adults. It affects both sexes equally. In infancy, common areas affected include the face and outer aspects of the limbs. During childhood, it usually affects the skin folds such as the elbow bends, back of knees and neck. The wrists and hands are also frequently involved, and the ankles and feet may also be affected. In adults, atopic eczema is seen predominantly in a flexural distribution, but extensive areas of skin may be involved. Eczema may also occur around the lips, the eyes and other parts of the skin.

The hallmark of atopic eczema is severe itch which may be worsened by sweating or wool clothing. Another cardinal feature is generalized dry skin which is present in up to 98% of atopic eczema patients.

What causes atopic eczema?

The cause of atopic eczema is still not fully known. However, it is thought to arise from an interaction between environmental and genetic factors. Alterations in the immune system are also thought to play a part in the development of eczema. In addition, the skin barrier in atopic eczema is impaired, leading to dryness and susceptibility to bacterial and viral skin infections. There are many factors, including allergies, infections, emotional, climatic and other environmental influences that contribute to the causation of atopic dermatitis.

Do I have allergies?

Respiratory allergy is frequently associated with childhood and adult atopic eczema. The most frequent allergens are house dust mites, pollen, animal dander and molds.

Food allergies occur primarily in up to 40% of infants and children with moderate to severe atopic eczema. Cow’s milk, eggs, peanuts, soy and wheat are the most common offenders. Fortunately children usually ‘outgrow’ sensitivities to food allergens, except that the reactivity to peanuts (as well as tree nuts, fish and shellfish) which tends to persist. In adults, food allergy is very uncommon. Screening tests for food allergy include skin prick test and specific IgE test called RAST test. The results of these tests must be interpreted by an experienced dermatologist.

Can atopic eczema be cured?

At present, there is no cure for atopic eczema. However, the skin condition can certainly be improved and controlled with good skin care and use of appropriate medications. In general, the eczema tends to improve as the child gets older. However, the eczema may still occur on and off, even in adulthood. Data have shown that up to 40% of patients with childhood atopic eczema have persistent or recurrent disease as adults.

How do I care for the skin?

The following are important advices in the skin care of people with atopic eczema:

  • No scratching, rubbing and picking the skin. This aggravates the eczema and may also lead to unsightly pigmentation, open wounds and scars. Keep fingernails short and clean.
  • Avoid irritating soaps, harsh chemicals and detergents. Soaps used should include gentle soaps or soap substitutes. Bubble baths and scented salts or oils may be irritating and should be avoided.
  • Swimming in chlorinated pools is allowed but patients are advised to shower immediately afterwards and to moisturize immediately.
  • Moisturize the skin frequently. Moisturizers do not cause thinning of the skin and should be applied liberally and frequently. The best time to apply moisturizers is right after a bath.
  • Certain clothing material such as woolen fabric and linen often irritate the skin and materials such as cotton are more comfortable for the atopic skin.
  • When in a dry or cold environment, it is important to keep the skin well moisturized to prevent aggravation of the eczema.
  • Scalp care should include a bland shampoo.
  • Relax, avoid emotional stress.

What treatments are available?

Conventional therapy includes avoidance of irritants when possible and the use of emollients to moisturize the skin. Topical corticosteroids have been the mainstay of treatment. Other therapies such as topical calcineurin inhibitors (Protopic® or Elidel®), light therapy, antibiotic, antihistamines and systemic immunosuppressive agents are used only in accordance with specific clinical situations, severity and treatment response. Treatments commonly prescribed for eczema include moisturizers and topical steroids.

Topical steroids are useful in reducing the inflammation. They are safe if used appropriately. Some possible side effects of prolonged use of steroids include skin thinning and atrophy. This may occur with prolonged and inappropriate use of topical steroids. Your doctor will advise you on the appropriate use of the topical steroids.

Oral treatments for atopic eczema include oral antibiotics, which are used only when the skin is infected. Antihistamines are commonly prescribed to reduce the itch.

Do traditional remedies or alternative therapies help?

Analysis of ‘herbal creams’ used by patients revealed that most contain super potent corticosteroid which if not used with cautious may result with severe local side effects. Oral Chinese medicine was studied in the treatment of atopic eczema and was found to be helpful in improving the symptoms in only 2 studies. It may however cause abdominal distension and headaches. Dietary lipid supplements such as evening primrose have been studied but showed no additional benefit. Hypnotherapy and massage therapy have also been shown to have some utility in the treatment of selected patients with atopic eczema but they are not recommended as the main therapy in this condition. Other therapies include salt baths and ionized water, but to date these have not been adequately studied.

My skin gets worst after exposed to dust, how do I get rid of the dust mites?

Complete avoidance of dust mites is very difficult. House dust mites are found everywhere including mattresses, pillows, bed sheet, clothes, soft toys, sofas and carpets. Simple but very effective measures to reduce the level of dust mites are as follows:

  • Change the bed sheet and pillowcases every week; soak in hot water >60oC for about half an hour before washing and subsequently sun dry.
  • Sun and vacuum clean the mattress at least once a week
  • No soft toys
  • Avoid using thick heavy curtain
  • Clothes and books should be kept in a closed cupboard
  • Avoid feather dusters. Damp dusting should be used to clean surfaces.
  • No carpets.
  • No pets.
  • Air-conditioners if used should be cleaned regularly.
Last reviewed : 23 October 2009
Writer : Dr. Tang Min Moon