Atopic Dermatitis

Atopic dermatitis, or eczema, is a chronic skin that causes areas of red, itchy skin. This condition usually starts in early childhood, especially when there is a family history of atopy (asthma, hay fever, conjunctivitis, or food allergies). The skin fails to hold in moisture, becomes dry, then inflamed, itchy and often infected. Various combinations of factors cause the dryness. Allergies leading to an overactive immune system and hereditary dry skin (ichthyosis vulgaris) are the most prominent internal and external factors.

To treat this disease you need to work with the doctor in identifying and reducing those factors in your or your child´s life that trigger of flare-up the disease. These are different for each person, so no one therapy is appropriate for all eczema patients. You need to watch for some of the following possible exacerbating factors (use the mouse to click on the item to learn more).

Treatment

Your skin is dry, not because it lacks grease or oil, but because it fails to retain water. Therefore, to correct dryness, water is added to the skin, followed by a grease or oil-containing substance to hold the water in.

Soaking the affected area, in a basin, bath, or shower, for 15-20 minutes using lukewarm water, can help to hydrate the skin. Hot water dries out the skin. Then, remove excess water by patting with a soft towel. Avoid vigorous use of a washcloth in cleansing. When toweling dry, do not rub the skin. Blot or pat dry so there is still some moisture left on the skin, and immediately apply a moisturizing cream (Eucerin Cream, Moisturel Cream, Cetaphil Cream). Moisturizing lotions contain some water, so they do not work as well. Use of moisturizers without first trapping in water is much less effective. Many patients find that two or three additional applications of moisturizers during the day give additional help.

Tar Preparations

Tars and extracts of crude coal tar are often used to reduce the amount of topical steroids needed in chronic maintenance of eczema. A pharmacist can make up One to five percent LCD (Liquor carbonis detergens) in a cream. Tar gel products (Estar Gel and Psorigel) are available, but they contain alcohol and may cause burning and irritation on already red and inflamed skin.

Steroids

Topical steroids are particularly useful to treat flare-ups of eczema. They help keep down the inflammation and itching. Apply them just on the rash (instead of the oil recommended above) especially after a soak or bath. Do not use topical steroids more than twice a day. Your pharmacist can provide topical steroids in large jars to reduce the cost.

 Hydrocortisone ointment or cream can be used for eczema in infants and young children, or in skin folds in adults. More potent topical steroids should not be used on thin-skinned areas of the face, neck, axilla, and groin. Short, supervised courses of medium potency topical steroids creams are safe and effective for flares of eczema on other parts of the body. Adverse effects of long term topical steroids include thinning of the skin (atrophy), a change in the color of some skin (depigmentation), and acne-like eruptions.

A newer class of topical drugs are the ´topical immunomodulators´ or TIMs. These locally calm down the immune system similar to topical steroids. However they don´t have the side effect of steroids in that they do not cause thinning of the skin with long term use. There are currently two of these drugs available: Protopic (tacrolimus) Ointment and Elidel (pimecrolimus) Cream. They can be used in patients two years of age or older.