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Atopic Dermatitis

Atopic dermatitis is a form of chronic eczema. It is often associated with a personal or family tendency toward asthma, hay fever or other allergies. Atopic dermatitis most commonly begins in infancy or early childhood, but can persist throughout life for some people.

Atopic dermatitis may affect any part of the body. One usually sees extremely dry skin with superimposed red, scaly patches of eczema. If a secondary bacterial infection occurs, there may be other areas of yellow dry crust or scabs. Infants often show involvement on the scalp and face. Older children are usually affected around the eyes and the bend of the elbows and knees. Adults may have similar areas of involvement or just chronic hand eczema.

Itching is the predominant symptom of atopic dermatitis. The itching can be overwhelming and unrelenting. Because of the subsequent scratching, the skin develops thick dry rough patches with color changes. No true scars occur but the color changes can be long lasting.

Since atopic dermatitis is a long-term skin disease, the goal of therapy is to keep it adequately controlled as no true cure exists that will permanently eliminate this allergic skin type. Because dry skin is itchy, the first step of therapy is keep the skin well lubricated. Bathing should be minimized, avoiding excessively hot water temperatures and using only mild fragrance-free soaps. Infants can be bathed with any of the standard baby cleansers. Older children and adults should use Dove, Cetaphil, Neutrogena or similar gentle soaps. The moisturizing liquid body washes are also useful. Most importantly, immediately after bathing a thick greasy cream or ointment moisturizer should be applied to the skin. The greasier the product, the better it works as a moisturizer. Plain Vaseline petroleum jelly is quite effective and can be spread if mixed with a little water left on the skin after a bath. Less greasy alternatives include the cream products sold in jars made by Cetaphil, Eucerin, Moisturel or others. These products may have to be applied repeatedly during the day if the skin feels dry to the touch.

Active patches of eczema are treated with prescription cortisone ointments. These should be applied twice daily for several days in a row until the flare is controlled, but then used only 2 or 3 times weekly if needed to maintain remission. Prolonged daily use of the stronger cortisone ointments has to be avoided as this can cause permanent thinning of the skin, especially thin-skinned areas such as the face, neck or creases in the arms and legs. Antihistamine pills or liquids can be given to help relieve the symptom of itching. Antibiotics are often useful for areas of secondary infection that tend to provoke flares of the eczema.

Although most people with atopic eczema have associated allergy problems, it is rare that one can improve the skin disease with allergy avoidance measures. Eczema is a different form of allergy than hives, asthma or hay fever and therefore it does not always improve with the same treatments that can be very useful for these other allergy problems.

Atopic dermatitis tends to improve with age but can persist into the adult years. Unfortunately, no true cure exists for this condition, but with strict attention to regular use of thick moisturizers along with intermittent use of appropriate prescription creams, most people can keep this skin disease under control.

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