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Atopic dermatitis (Eczema)

Atopic dermatitis (Eczema)

 

Atopic dermatitis is a common, chronic skin disorder where individuals have inflammation of the skin leading to chronic skin itch. It usually presents in early childhood, and generally improves as people age. Its severity naturally fluctuates over time. It is estimated to affect 10-20% of children and 1-3% of adults in developed countries. It can be associated with other allergic conditions including allergic rhinitis (hay fever), asthma and food allergy.

Etiology

The cause of atopic dermatitis is not completely understood but there is a known genetic component. Individuals with atopic dermatitis have defects in their skin barrier which leads to water loss. This manifests as hypersensitive and easily irritated dry skin. Because of the defect in the skin barrier, individuals with atopic dermatitis are also more prone to skin infections. Although foods may worsen atopic dermatitis in a small number of individuals, foods are not the cause of atopic dermatitis. Complete elimination of specific foods from the diet should not occur in individuals with atopic dermatitis as this can potentially create an anaphylactic food allergy, especially in children.

Diagnosis

There is no specific diagnostic test for atopic dermatitis. Diagnosis is based on the history of symptoms and physical examination by your doctor. Response to standardized treatment can also support the diagnosis.

Treatment

The treatment of atopic dermatitis is focused on restoring the skin barrier which can repair the skin, limit itching and decrease inflammation. Daily bathing is encouraged in lukewarm water and a barrier cream (e.g. CereVe®, Glaxal Base®, Vasaline®) should be applied liberally and regularly, especially after bathing. Creams and ointments are more effective than lotions at trapping in moisture. Use of scented or fragranced soaps, lotions and detergents is discouraged as these can irritate the skin. For those with flares of their eczema, use of a topical corticosteroid can help to decrease inflammation. There are many different strengths of topical corticosteroids that are used on different areas of the body. Your doctor will prescribe the most appropriate topical corticosteroid for you. When used appropriately, topical corticosteroids are very safe and effective at treating eczema. Side effects are uncommon with low or moderate potency corticosteroids. Other topical creams are available (e.g. tacrolimus (Protopic®), pimecrolimus (Elidel®), crisaborole (Eucrisa®)) and are used for either persistent disease or as an alternative to topical corticosteroids. For those with more severe disease, other treatments such as ultraviolet (UV) phototherapy, immunosuppressants and biologic agents (e.g. dupilumab (Dupixent®) can be effective.