Atopic dermatitis (AD), also called atopic eczema, is a chronic allergic skin disease that usually occurs in people who have an atopy.  These people may develop any or all of three closely linked allergic conditions: atopic dermatitis, asthma, and hay fever (allergic rhinitis).  Atopic conditions have a genetic predisposition and, therefore, usually run within families. However, up to 30% of AD sufferers have no identifiable family history of atopic disease.

People with AD have a functional defect in their skin which prevents it from staying moist.  Their skin is dry, itchy, and easily irritated.  Scratching dry and itchy skin causes a rash, leading to more irritation, itchiness, and ultimately more scratching.  The inflamed skin allows irritants, allergens, bacteria, and viruses to easily enter, causing even further inflammation.  Food allergens and inhaled allergens, particularly dust mites and animal dander, can also aggravate AD.

Atopic dermatitis usually begins during the first year of life and always within the first five years.  It is often at its worst between the ages of two and four.  However, AD generally improves after two to four years of age and may clear altogether by adolescence in babies, the rash usually starts on the face or over the elbows and knees, which are easy to scratch and rub.  It may spread to involve all areas of the body.  Later in childhood, the rash typically settles in the elbows and knee folds.  Other common areas for rashes include the hands, feet, scalp, or behind the ears.

The most important prevention and treatment for dry skin is to “soak and seal” water in the skin daily.  After soaking in a bath, pat dry and immediately apply a thick layer of moisturizer, such as petroleum jelly or cream, to seal in the water. Chemicals, solvents, soaps, detergents, fragrances, and many synthetic fabrics are irritants and should be avoided.  Cotton is best for all seasons, especially summer.  For cool weather, layering is a great idea.  Low humidity, high humidity and sweating can dry and irritate the skin.  Therefore, avoid overheating the home.  Since children with eczema are often prone to other allergies, keep family pets outdoors or at least off beds and sofas.  Control dust mites with coverings for pillows and mattresses and frequently wash bedclothes in hot water.

Antihistamines such as Benadryl, provided particularly at night, are crucial to controlling itching.  Topical steroids may be used to calm the inflamed skin.  Other special topical creams such as Elidel (pimecrolimus cream) or Protopic (tacrolimus ointment) also treat inflammation, but do not cause steroid side effects.  If necessary, it is important to treat infection early with antibiotics.  In rare but severe cases, immunosuppressive agents such as cyclosporine, methotrexate or azathioprine may be indicated.