Eczema

Eczema or atopic dermatitis, is known as the “itch that rashes.” It almost always begins in childhood, frequently during infancy, and can persist into adulthood.  The overall incidence of eczema is increasing, and a family history of eczema greatly increases the chances of developing this skin condition.  Eczema is often one of three health conditions that run together in families called the "atopic triad."  The atopic triad consists of eczema, allergic rhinitis (seasonal allergies), and asthma.   Three stages of eczema exist depending on the age of the affected individual.  Infantile atopic dermatitis occurs from age 2 months to 2 years of age.  Childhood atopic dermatitis occurs from 2 to 10 years of age.  Adult atopic dermatitis occurs as an individual reaches adulthood.  The areas affected by eczema depends greatly on the stage of atopic dermatitis.   Eczema presents as dry patches with underlying redness. It frequently affects the hands, feet, inner elbow and knees, as well as the face or neck.  Infants and young children are frequently affected on the cheeks, face, and neck.  The itching associated with eczema can often disturb one’s sleep in severe cases.  Scratching the areas of eczema often leads to skin thickening called lichenification.  Worsening of eczema can occur after immunizations and viral infections.  Stress and staph bacterial infections can worsen the condition.  Super infection of eczema patches with staph bacterial infection is termed impetiginization.   Eczema may also be demonstrated by other findings on the skin .  Pityriasis alba, patchy white flaky areas on the cheeks, is a manifestation of eczema.  The area around the mouth may appear whiter than the rest of the skin and is called "perioral pallor."  Frequent drippy noses and irritation cause rubbing of the nose resulting in a crease over the nasal bridge called a nasal crease.  Extra skin folds around the eyes are termed Dennie Morgan folds.  One percent of patients also have a cone-shaped deformation of the cornea of the eye called keratoconus.   Treatment can control eczema; there is no cure. Successful treatment begins with repairing the damaged and disrupted skin barrier using appropriate, gentle cleansers and adequate moisturizers, especially those that contain ceramides (CeraVe,™ Cetaphil®). Topical steroids, and non-steroid topical calcineurin inhibitors (Protopic® ointment, Elidel® cream) are used as prescription medications to treat flares. Oral antihistimines are important to control itching and stop the itch-scratch cycle.  Very dilute bleach baths (the concentration is carefully explained by a dermatologist and should be done only under physician advisement) several times a week suppresses staph bacteria on the skin and can help to control severe eczema flares in select cases.