What is atopic eczema?

Atopic eczema is a common skin disease that frequently develops in childhood. It is estimated that the disease is seen in one out of every 5 children. The term ‘atopic’ is used for the trio of asthma, eczema and allergic rhinitis characterized by enhanced allergic reactions. Eczema implies the red, dry, itchy skin that is sometimes associated with blisters, discharge and thickening.

What causes atopic eczema?

Atopic eczema is a complex condition that is caused by many factors such as environmental ones in addition to personal predisposition. The skin barrier of the patients impairs and allergic responses are severe. Besides, environmental factors include use of soap and detergent, chemicals, exposure to allergens as well as certain bacterial and viral infections. The protein filaggrin allows protection of healthy skin barrier and its close relation with development of eczema has been shown. The genetic disorders related to this protein make the atopic dermatitis patients more vulnerable to the infections and allow chemicals to pass through the skin easily and thus, contribute to development of itching and eczema.  

Symptoms of Atopic Eczema

The principal symptom of atopic eczema is itching. The act of scratching in response to itching worsens the eczema.  Patients experience difficulty in sleeping due to severe itching and become tired and nervous on the next day. Sometimes, patients have recovery and exacerbation periods. The symptoms have a tendency to worsen as the skin gets dry in winter.
Symptoms of atopic eczema vary depending on the age at onset. Red, scurfy patches and seldom discharge as well as yellow crusts can be observed on cheeks, hands and outer surfaces of arms and legs in the infancy. The skin is typically dry. In childhood, eczema plaques are seen in skin folds. In adulthood, the disease is observed in form of hand eczema, eyelid eczema (dermatitis) and erythroderma that is characterized by redness and scurf in more than 90% of entire body as well as a clinical picture characterized by eczema plaques in skin folds or outer surfaces.

What are the factors that cause exacerbation of atopic eczema?

  • Soap, detergent, various chemicals, hot temperature, dust, woolen clothes and animals
  • Infections like flu and common cold
  • Bacterial infections (S.aureus), viral infections (Herpes) of the skin
  • Dry skin
  • Food allergies, although rare
  • Stress

How Is Atopic Eczema Diagnosed?

Atopic eczema is diagnosed easily in the light of clinical signs. Sometimes, elevated serum immunoglobulin E, increased eosinophil count and positive response to respiratory or food allergies in skin prick test may be necessary to support the diagnosis.

Treatment of Atopic Eczema

Eczema develops during adolescence in sixty percent of atopic eczema patients. Treatment of atopic dermatitis aims to take the disease under control; in other words, the disease is not curable.
Treatment of atopic eczema is based on moisturizing the skin. Moisturizers should be used regularly (at least once a day) and scentless, colorless cleaners that do not contain soap should be used while cleaning the skin. The patient should select the one that he/she can use more easily among various moisturizers.

Topical Steroids (Cortisone Creams)

They are effective on redness and itching in eczema plaques. There are creams and pomades with varying potency depending on the region and patient’s age. Physicians prescribe the topical steroids for a certain duration and potency depending on the affected body part. As the long-term use leads to side effects, such as thin skin or formation of capillaries, they should be used strictly as instructed by the physician. They are quite effective when used properly.

Topical Calcineurin Inhibitors

They can be used for the patients who do not respond to cortisone creams or have contraindications for topical steroids. The most common side effects are sensation of burn and irritation, but those effects disappear following several administrations.

Wrap Therapies

Cotton bandages or cotton/silk clothes are worn on the parts where the cream is applied and they both boost the absorption of creams and alleviate itching. Wet wraps can be used for short periods.

Phototherapy (Ultraviolet Therapy)

Ultraviolet therapy is performed in certain number of sessions and it is effective for most of the patients.

Other treatments

Topical treatments are not sufficient for patients with disseminated eczema and they need oral treatments and injections. These treatments include;
  • Cortisone therapy
  • Cyclosporin
  • Dupilumab
  • Azathiopurine
  • Methotrexate
  • Mycophenolate mofetil  
. These treatments require close supervision by the physician along with certain blood tests at regular intervals.

What Are the Considerations for Self-care?

  • Try moisturizing your skin twice a day
  • Use moisturizing washing products instead of soap; do not use shower gels and shower foams
  • You should necessarily wear gloves while doing housework and avoid the rubber ones and gloves with powder
  • Immediately take a shower and apply moisturizer after swimming
  • Wear cotton clothes and avoid nylon or woolen clothes
  • Do not itch or scratch the affected body parts; try to relieve your skin by smoothly applying a moisturizer in case of itching
  • Avoid too warm environments
  • Rinse your clothes twice, if possible, and remove the detergent residues properly