Understanding Eczema

Atopic dermatitis signs and treatment options.

Approximately 30 million Americans have some form of eczema, a non-contagious incurable skin disease. Also known as atopic dermatitis (AD) or atopic eczema, eczema affects about 10 percent of infants and children. While its exact cause is unknown, eczema usually results from a combination of family heredity and various conditions that trigger the red, itchy rash.

Is it atopic dermatitis?

  • Time of onset. AD begins during the first year of life and almost always presents within the first five years. It's seldom present at birth, but it often comes on during an infant's first six weeks. Whereas other rashes can start at any time and most of them disappear within a few days to weeks, AD tends to persist. It may wax and wane, but it keeps coming back.
  • Itching. Atopic dermatitis is a very itchy rash. Much of the skin damage comes from scratching and rubbing that the child cannot control.
  • Rash location. In babies, the rash usually starts on the face or over elbows and knees. Later in childhood, the rash is typically in the elbow and knee folds. Rashes on the hands, feet, scalp, or behind the ears might also point to AD.
  • Rash appearance. Although appearance is different from one person to another, scratch marks and scaly, dry skin are common. The skin may become infected and show yellow crusts or little pus-filled bumps. The skin also may thicken from long-term scratching and rubbing.
  • Heredity. If other family members or relatives have AD, asthma, or hay fever, the diagnosis of AD is more likely.
  • The bottom line. Be sure to get your child diagnosed by a physician.

Causes and triggers

AD inflammation results from too many reactive inflammatory cells being in the skin. When something triggers them, they don't turn off as they should. We try to control AD by controlling the trigger factors that "turn on" inflamed skin, or by "dampening the flames" with anti-inflammatory therapies. Trigger factors are different for everyone. Most children's symptoms worsen when they get a cold or other infection. Some people have discomfort in the winter, and others simply cannot stand the sweating during summer weather. The following triggers seem to affect every child with AD.

  • Dry skin. People with AD have a defect in their skin so it won't stay moist. It is especially bad in winter when the heat is on in the house and the humidity drops. Too much bathing without proper moisturizing is an issue, too.
  • Irritants. Irritants are any of the substances outside the body that can cause skin burning, redness, itching, or dryness.
  • Stress. People with AD often react to stress by having red flushing and itching. And, of course, AD itself, and its treatments, are a source of stress!
  • Heat and sweating. Most people with atopic dermatitis notice that when they get hot, they itch. They have a type of prickly heat that occurs anytime they sweat.
  • Infections. Bacterial staph infections are the most common type for people with AD. Such infections might be suspected if areas are weeping or crusted or if small "pus-bumps" are seen. A common viral infection, molluscum contagiosum, tends to be more severe in children with AD. Herpes infections (such as fever blisters or cold sores) and fungus can also trigger AD. If lesions look suspicious, ask your doctor about them.
  • Allergens. The slower, chronic eczema of AD may be difficult to tie to specific allergens. Food allergies can trigger flares, while pollens, dust mites, and pets can seldom do so.

Children may avoid triggers by moisturizing, wearing soft and breathable clothes, limiting exertion and sweat during flares, taking a cool shower or bath when itching due to sweat, tracking potential food allergens with a doctor's guidance, limiting exposure to allergens (keeping pets off furniture, removing dusty carpets), and by learning to positively cope with stress. Family members should also be able to recognize and and treat infections.

What treatments may help?

  • Moisturizers
  • Corticosteroids
  • Topical Immunomodulators (TIMs), a family of topical medications
  • Tar preparations, such as creams or bath emulsions
  • Oral or topical antibiotics
  • Antihistamines

Any treatment options should be discussed with your doctor, and there is the chance that children may outgrow AD. The majority of babies with AD will lose most of the problem by adolescence, often before grade school. A small number of them will have severe AD into adulthood. Many people have remissions that last for years. The dry skin tendency often remains, but most people learn how to keep their dermatitis controlled.