Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Atopic Dermatitis Update

Category: Asthma and Allergy


Atopic dermatitis is a common form of eczema or weeping rash disease found in childhood. Over 80% of cases begin before one year of age and 95% before five. The prevalence of atopic dermatitis seems to have increased over the past several decades and now approaches over 10 to 15 percent of the population at some time during their lifetime.

Atopic dermatitis is almost always found in children of allergic families. In other words, members of their family tree usually have other type allergic problems including hay fever and asthma and may also have atopic eczema. Atopic dermatitis or atopic eczema is characterized by red, itchy skin lesions that may peel, blister and weep. Other forms of eczema which are different than atopic eczema include seborrhea and contact dermatitis. Atopic dermatitis usually presents in early childhood with characteristic patchy itching rash areas which are red and scaly. They are frequently found on the facial cheeks, trunk and extremities in children. The exact locations on the body seems to change with age, moving away from the face and more to the flexural areas such as behind the knees and in the crease of the arms as a child gets older. Itching is the hallmark symptom of atopic dermatitis and the disease is often described as "The itch that rashes". Secondary to this itching, the skin tends to break down and develop problems with staph bacteria and occasionally funguses.

Another characteristic of eczema is abnormal water loss from the surface of the skin. For these two reasons it is critical that patients with eczema use mild soaps and moisturizing agents on a regular basis to minimize over drying. It also helps to minimize bathing and occasionally to use non-soaps such as cetaphyl cleanser or other options. Control of the itching and scratching is also critical. This is usually done by avoiding scratchy clothes and sticking to more natural breathable clothing such as cotton. Also use of antihistamines is generally helpful. The old standards were Benadryl and Attarax and Periactin. Now we have some non-sedating antihistamine options including Seldane, Hismanal and the soon to be released Cyterizene. I personally have found good success with Hismanal and am looking forward to trying Cyterizene as soon as it hits the American market. Patients with eczema almost always have a family history of allergy and often have other allergies themselves including asthma and hay fever. They may be allergic to foods and pollens or irritants. It is worth trying to isolate and avoid any foods, pollens or irritants which flare up the disease. In many cases, however, no specific trigger factor can be pinpointed other than overheating, over drying and over itching of the skin.

Besides controlling the moisture in the skin and the itch problem, it is important to reverse the thick leathery skin changes by using corticosteroid creams. In most cases, it is best to use a mild corticosteroid cream because of the need to use these over months to years. This would include low potency medicines such as 1% Hydrocortisone, Tridesilon, Elocon and Westcort. Occasionally, stronger mid- and high-potency corticosteriods are needed for more severe body skin changes. Caution should always be used when using high potency corticosteroid on any part of the body for any length of time. Research is ongoing in creating new medicines which can block the itching in the skin and reverse some of the changes at the skin level. Other less commonly used old remedies which may be worthwhile include tar preparations. I personally found lots of success using crude coal tar and petrolatum in a 3% solution. This is a nasty, staining compound but it does a good job of decreasing the itch and allowing the skin to begin healing. I always tell families to use old pajamas and sheets when using this preparation and use it only at bedtime.

In an interesting questionnaire given to parents of children with both atopic dermatitis and asthma, the parents chose asthma as the disease they felt they could handle better and the one they would keep if they had to keep one of the two. This signifies that atopic dermatitis is a chronic recurrent disease which is more difficult to control and cure than asthma. I usually describe it as a frustrating disease which cannot be cured but most certainly can be controlled with proper therapy. Hopefully, with new medicines such as Cyterazine and numerous other drugs being researched, we will one day have a true cure for this chronic nuisance disease so common in childhood.