Atopic Dermatitis (Atopic Eczema)

 I.  Definition:
          Atopic dermatitis (atopic eczema or just eczema) is a name given to a stubborn itchy rash that occurs in certain people with sensitive or irritable skin.  Eczema is common in infants and young children, and may disappear before adulthood.  Eczema may clear for years, only to reappear later--often on the hands.
 
II.  Cause:
 

• The cause is unknown.  It's the result of a built-in defect of the skin that tends to run in families.  This defect causes the skin to lose water and to become dry compared to normal skin.  Eczema is not contagious and is not related to your general health.

 

• People with eczema have skin that is dry and easily irritated by soap, detergents, and rough wool clothing.  Clothes washed or dried with liquid or sheet fabric softeners such as Cling, may also irritate the skin.  Hot and cold weather often aggravates eczema.  Certain allergies may worsen eczema, but they don't cause it.

 

• People with atopic eczema have a greater incidence of asthma and hayfever in themselves and in their families.

 
III.  Treatment:
 

• Since eczema patients have a constitutional skin defect, no permanent cure is possible.  However, there are effective ways of controlling it.

 

• Vaseline and cortisone compounds applied to the skin are the best medicines for controlling eczema.  Most cortisone salves can be used safely for years.  When large areas of the body are treated with strong cortisone preparations, periodic medical check ups are necessary.  Strong cortisones shouldn't be applied to the face, armpits, groin, or rectal area.  

 

• When using cortisone ointments always remember to use a little and massage it in well.

 

• For stubborn eczema, salves containing coal tar can be helpful.  However, it smells and stains the clothing.

 

• Keep the skin lubricated.  Use a bath oil or Aveno powder in the tub.  Do not take more than one bath or shower a day.  Use lukewarm water, not hot.  Hot water dries out the skin.  When toweling dry don't rub.  Blot the skin so there is still some water left on the skin.  Then apply a moisturizer to all of the skin such as Vaseline, Lubriderm, or Moisturel.

 

• Soap irritates and dries the skin, so keep it away from your eczema.  When bathing limit the use of soap to your face, armpits, genital area, and feet.  Use Cetaphil soap, Oil of Olay, Dove or Basis.  If hands are washed frequently, dry carefully then apply a little Vaseline.

 

• Hot weather and heavy sweating tend to worsen eczema.  Wear cool, loose clothing, and try to stay in air conditioned buildings.

 

• When laundering the clothes, use no fabric softener, Cling or dryer sheets.  Wash the clothes using dye free, fragrance free detergents or Ivory Snow.

 

• Avoid contact with wool or rough clothing.  Cotton clothes, (100%) are best.

 

• Avoid make-ups, perfumes, etc. that may cause itching or irritation.

 

• It is possible to find a treatment routine that lets you control your eczema.  Usually with cortisone creams or ointments and a lot of Vaseline.

 

• If your eczema worsens and you can't control it, return to the office so we can adjust your medications.

 
IV.  Treatment Summary:
 
Bathing:

• Take only one bath or shower a day
• Bathe using a mild soap such as Oil of Olay, Dove, Basis, or a soapless skin cleanser such as Cetaphil lotion
• Bathe briefly in lukewarm water, not real hot water
• Do not soak in the tub or shower longer than necessary
• After bathing, pat the skin dry with a towel, do not rub
• Apply moisturizer to the skin after the bath, plain greasy Vaseline works best

•   Apply hydrocortisone 1% ointment to worst areas 1-2 times a day

 
Laundry:

• Wear 100% Cotton clothing as much as possible
• Use Ivory Snow detergent or dye free, fragrance free detergents for washing clothes
• Do not use fabric softener or dryer sheets

 
Sleeping:

• If the patient is having trouble sleeping try Benadryl elixir or capsules