Eczema (Atopic Dermatitis)
What is eczema?
Eczema is also called atopic dermatitis (AD). It is a common inflammatory skin disease that affects up to 13% of children and 10% of adults in the US. AD is chronic and tends to flare with triggers. The red, itchy and inflamed patches can appear anywhere on the body. Eczema is a systemic disease that causes inflamed, irritated and itchy skin. Scratching causes inflammation, swelling, cracking, weeping skin with crusting and scaling. It is not contagious but has a considerable impact on quality of life.
95% of people develop eczema before age 5 and the condition frequently persists into adulthood. In infancy eczema appears as itchy, red, scaly patches on the baby’s face or chest. Usually the condition goes away as the child grows, but not always. Even when the red, itchy patches resolve, the child can be left with easily irritated, dry, sensitive skin.
What causes eczema?
Many factors contribute to the development of eczema including genetic susceptibility, environmental factors, microbiome effects and immune system dysregulation. A family history of allergic diseases like hay fever or asthma is an important risk factor.
What are the symptoms?
Infant AD is usually acute, with lesions on the face, trunk and limbs. Children aged one and above manifest skin lesions (red patches) around the mouth, on the neck, behind the knees and inside the elbows. Adolescents and adults manifest thickened or scratched lesions behind the knees and inside of the elbows, on the wrists, ankles and eyelids, around the mouth and on the hands. AD may be mild, moderate or severe. Despite the various manifestations the condition is treated as a single disease.
Complications include skin infections from constant scratching that creates open sores, and contact dermatitis from harsh soaps, detergents and disinfectants. The itch-scratch cycle can interfere with sleep, and the more the itch is scratched, the more it itches. Triggers include sweat, stress, heat, itchy fabrics, fragrances, pet dander, environmental allergies, soaps, detergents, dust and pollen, and hot dry air. Some food allergies can also trigger flares.
How is eczema diagnosed?
There is no objective test to confirm a diagnosis of atopic dermatitis. Board-certified medical dermatologist Dr. Dhaval Bhanusali will diagnose the disease based upon the clinical features, and a medical history. Diagnosis requires exclusion of other skin conditions with similar appearance including infections and other inflammatory skin conditions. It may also include performing a patch test where a small amount of an allergen is placed on the skin and is checked for skin reactions within a day or two.
How is AD treated?
The goal is the manage AD to prevent worsening of the disease, calm the skin, control itching, and prevent infections and skin thickening. Traditional treatments involve topical and oral medications. Moisturizers are essential to maintain the integrity of the skin barrier. The skin barrier keeps out bacteria, allergens and irritants that aggravate AD. Topical anti-inflammatory medications reduce inflammation, itching and redness.
Treatments for adults with stubborn or severe disease include phototherapy, immunosuppressants and short courses of steroids. Long-term topical treatment is frequently needed. Newer therapies include crisaborole (Eucrisaâ) ointment for mild to moderate AD, and dupilumab (Dupixentâ) for moderate to severe AD.
Hudson Dermatology & Laser Surgery is one of the leading dermatology practices in New York City. Located in the beautiful new Hudson Yards development, we’re hopefully conveniently located near you. If you are concerned about red, itchy patches of skin on your child’s face or body, or your suffer with chronic skin irritations, schedule an dermatology appointment today. From diagnosis to treatment and management, we can help.