By Cathy Lovering
Atopic dermatitis (eczema) is a condition that causes dry, itchy and inflamed skin. It’s common in young children but can occur at any age. Atopic dermatitis is long lasting (chronic) and tends to flare sometimes. It can be irritating but it’s not contagious.
People with atopic dermatitis are at risk of developing food allergies, hay fever, and asthma.
Moisturizing regularly and following other skin care habits can relieve itching and prevent new outbreaks (flares). Treatment may also include medicated ointments or creams.
Diagnosis
To diagnose atopic dermatitis, your healthcare provider will likely talk with you about your symptoms, examine your skin and review your medical history. You may need tests to identify allergies and rule out other skin diseases. If you think a certain food caused your child’s rash, ask your health care provider about potential food allergies.
Patch testing
Your doctor may recommend patch testing on your skin. In this test, small amounts of different substances are applied to your skin and then covered. During visits over the next few days, the doctor looks at your skin for signs of a reaction. Patch testing can help diagnose specific types of allergies causing your dermatitis.
Treatment
Treatment of atopic dermatitis may start with regular moisturizing and other self-care habits. If these don’t help, your healthcare provider might suggest medicated creams that control itching and help repair skin. These are sometimes combined with other treatments. Atopic dermatitis can be persistent. You may need to try various treatments over months or years to control it. And even if treatment is successful, symptoms may return (flare).
Medications
• Medicated products applied to the skin. Many options are available to help control itching and repair the skin. Products are available in various strengths and as creams, gels, and ointments. Talk with your healthcare provider about the options and your preferences. Whatever you use, apply it as directed (often twice a day), before you moisturize. Overuse of a corticosteroid product applied to the skin may cause side effects, such as thinning skin.
• Creams or ointments with a calcineurin inhibitor might be a good option for those over age 2. Examples include tacrolimus (Protopic) and pimecrolimus (Elidel). Apply it as directed, before you moisturize. Avoid strong sunlight when using these products.
• The Food and Drug Administration requires that these products have a black box warning about the risk of lymphoma. This warning is based on rare cases of lymphoma among people using topical calcineurin inhibitors. After 10 years of study, no causal relationship between these products and lymphoma and no increased risk of cancer have been found.
• Drugs to fight infection. Your healthcare provider may prescribe antibiotic pills to treat an infection.
• Pills that control inflammation. For more severe eczema, your healthcare provider may prescribe pills to help control your symptoms. Options might include cyclosporine, methotrexate, prednisone, mycophenolate, and azathioprine. These pills are effective but can’t be used long term because of potential serious side effects.
• Other options for severe eczema. The injectable biologics (monoclonal antibodies) dupilumab (Dupixent) and tralokinumab (Adbry) might be options for people with moderate to severe disease who don’t respond well to other treatment. Studies show that it’s safe and effective in easing the symptoms of atopic dermatitis. Dupilumab is for people over age 6. Tralokinumab is for adults. Relaxation, behavior modification and biofeedback. These approaches may help people who scratch out of habit.
Baby eczema
Treatment for eczema in babies (infantile eczema) includes:
• Identifying and avoiding skin irritants • Avoiding extreme temperatures • Giving your baby a short bath in warm water and applying a cream or ointment while the skin is still damp
See your baby’s healthcare provider if these steps don’t improve the rash or it looks infected. Your baby might need a prescription medication to control the rash or treat an infection. Your healthcare provider might also recommend an oral antihistamine to help lessen the itch and cause drowsiness, which may be helpful for nighttime itching and discomfort. The type of antihistamine that causes drowsiness may negatively affect the school performance of some children.
