Atopic Dermatitis

What is atopic dermatitis?

Often called eczema or atopic eczema, this is a condition that usually develops by 5 years of age and causes extremely itchy rashes that come and go.

Atopic dermatitis (AD) is common worldwide. People of all ages from newborns to adults 65 years of age and older live with this condition. Symptoms range from excessively dry, itchy skin to painful, itchy rashes that cause sleepless nights and interfere with everyday life.

1 in 10 Americans has atopic dermatitis.

In the United States, research indicates that African American and Asian American children develop AD more often than white children.  When a child has deeply pigmented skin, AD tends to be diagnosed later in life. Sometimes, the condition is missed altogether because it’s less noticeable. In brown or black skin, you tend to see gray to violet-brown skin discoloration rather than red rashes.

What’s the difference between eczema and AD?

Eczema refers to a group of conditions that cause inflamed skin. There are many types of eczema. Atopic dermatitis is the most common type.  Other types of eczema include:

  • contact dermatitis
  • nummular eczema
  • dyshidrotic eczema

While AD is only one type of eczema, it can develop on the skin in many ways.

Causes

What causes atopic dermatitis?

This is a complex disease. Researchers have discovered that the following likely play a role in causing atopic dermatitis (AD):

  • Family history of AD, food allergies, asthma, or hay fever
  • Immune system
  • Where you live
  • What you’re exposed to in everyday life, such as stress, pollution, and tobacco smoke

AD runs in families: Researchers have found you are more likely to develop AD if blood relatives have (or had) AD, food allergies, asthma, or hay fever. These findings mean that genes are involved in causing AD.

In fact, researchers have found that certain genes affect a part of your skin called the epidermal barrier. This is the outer layer of skin that protects us from losing too much water and prevents germs from getting in through your skin. AD causes gaps in this outer layer, which seem to be inherited just like your eye color.

Who gets AD?

  • AD is common in children. As many as 25% of children in the United States may have AD. Most develop AD by their 5th birthday. Adults also develop AD, but this is less common. Although rare, AD can even start after 60 years of age.
  • Many children who have AD see the condition disappear by the time they reach 12 years of age. AD can also be a lifelong condition. It’s estimated that 2% to 10% of adults have AD.
  • Race also plays a role in who gets AD. Asians and blacks are more likely to develop AD than whites. In the United States, African American and Asian American children are more likely to get AD than white children.

If you suspect that you or your child may have AD, it’s important to get diagnosed. Treatment can prevent AD from worsening.

Source: American Academy of Dermatology

Dermatologists recommend moisturizer for everyone who has atopic dermatitis. Keeping your skin well moisturized helps to prevent cracks and fissures in your skin.

Diagnosis

To diagnose atopic dermatitis (AD), a board-certified dermatologist carefully examines your (your child’s) skin and asks questions:

  1. Do any of your blood relatives have AD, asthma, or hay fever?
  2. What are your symptoms?
  3. When did the symptoms begin?
  4. Where do the rashes appear on the skin?

Providing your dermatologist with this information can be very helpful. AD tends to wax and wane, so you may have clear skin when you see your dermatologist.

A skin exam along with information about your health and symptoms may be all that are needed to diagnose AD. Some people also need a skin biopsy.  Your dermatologist can quickly and easily perform a skin biopsy during your appointment. To do this, your dermatologist will numb and remove a tiny amount of skin. When looked at under a microscope, this can provide valuable information.  Having a skin biopsy can also help your dermatologist select the best treatment.

Treatment

Atopic dermatitis is a condition that cannot be cured, but proper treatment can control it. A treatment plan created by a board-certified dermatologist can help to:

  • Reduce flare-ups
  • Ease symptoms, such as itch and pain
  • Prevent AD from worsening
  • Decrease your risk of developing thickened skin, which tends to itch all the time
  • Keep your skin moist
  • Lower your risk of infection

While a dermatologist tailors each AD treatment plan to a patient’s individual needs, most treatment plans include the following:

  1. A skin care plan for AD including bathing, applying moisturizer, being gentle with your skin.
  2. Trigger management: AD can make the skin very sensitive and very reactive. Things that you come into contact with every day can cause AD flare-ups so it’s important to find your triggers and figure out how to avoid them. Common triggers include skin care products, weather (cold or hot), wool clothing, stress, and laundry detergents that contain fragrance.
  3. Medication applied to the skin: Your treatment plan may include medication that you apply to your skin, light treatments, medication that works throughout the body, or some combination of these.

Most people can control AD with medication that they apply to their skin. When this is part of your treatment plan, you may apply one or more of the following:

  • A corticosteroid
  • Crisaborole ointment
  • Pimecrolimus cream or tacrolimus ointment
  • Coal tar

Applying medication to your skin as directed can improve your skin’s ability to keep out germs and everyday substances that can irritate it. This means fewer flare-ups. The medication should also improve your skin’s ability to lock in moisture, so you’ll have fewer cracks and fissures.

Some people need stronger treatment for their AD. For these patients, a dermatologist may prescribe phototherapy or a medication that works throughout the body.

  • Phototherapy is another word for light treatments that can safely and effectively treat AD, even in children. Phototherapy works by exposing your skin to ultraviolet (UV) light. It’s given at a dermatologist’s office, hospital, or phototherapy treatment center.
  • For phototherapy to be effective, you will need 2 to 3 treatments per week for the amount of time prescribed by your dermatologist. For most people, this means going to the treatment center 2 to 3 times per week for a few weeks to a few months.
  • If you find it difficult to keep your appointments for phototherapy, tell your dermatologist. Don’t try to use tanning beds instead of phototherapy. Phototherapy differs from tanning beds, which pose risks to your health.
  • Using a tanning bed to treat AD increases your risk of developing skin cancer dramatically. If you use tanning beds before age 35, you can increase your risk of melanoma, the deadliest form of skin cancer, by 59%.
  • Medication that works throughout your body may be prescribed to treat widespread AD. Also called “systemic treatment,” this medication works on the immune system and can bring tremendous relief.

By partnering with a board-certified dermatologist, you can control AD. With control, it’s possible to relieve the extremely dry skin, alleviate the itch, and reduce flare-ups that lead to rashes.

Source: American Academy of Dermatology

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