Common Diagnosis
Eczema (Atopic Dermatitis)
Eczema or Atopic dermatitis is a condition of the skin where very itchy red scaly patches erupt on the body. It is more common in children, but many adults suffer from this condition as well. The best way to think of it is that the skin is much more sensitive than usual and itches much easier than a “normal” persons skin. Since this increased sensitivity is inherent, we cannot “cure” atopic dermatitis and can only hope to control it well enough to provide comfort and relief for the patient. The good news is that it will improve with age. The bad news is that it usually lasts in a severe enough form to require treatment for many years.
Treatment of atopic dermatitis centers around maintaining the waterproof barrier that skin provides for our bodies. Patients with atopic dermatitis lose more water from their skin than normal. Therefore, we encourage bathing once a day with a mild soap or soapless cleanser to replace that lost moisture, then immediately after bathing, applying an emolient CREAM to the entire body to seal it in. During flare ups, we add a mild steroid to this cream to speed the recovery of the skin. For many patients this is enough to keep them under control. However, for some patients another, stronger, cream needs to be applied to the dry itchy patches usually seen in the bends of the arms and legs, and around the wrists and ankles. Occasionally, an atopic dermatitis patient will have scratched and damaged the skin so much, that it becomes infected and we have to treat with an antibiotic. Sometimes, antihistamines are used, but they do not provide much relief from the itching—instead they induce drowsiness and allow the patient to fall asleep easier without scratching.
Many parents are concerned about the use of steroids for atopic dermatitis. Just like any other medication for other medical conditions, when used appropriately they are safe. The worry is overuse or abuse which can be avoided by developing a good relationship with your dermatologist and pediatrician. There are new medications, however, for atopic dermatitis that are steroid-free (Elidel and Protopic). These medications are an option for some patients.
Allergies to foods or other things are rarely a factor in Atopic dermatitis. However, in cases that are difficult to control, or where a connection seems to exist, an allergy workup can be helpful.
Greenville Dermatology considers eczema and atopic dermatitis to be one of our specialties. Please come for an evaluation and to develop a treatment strategy.