Atopic Dermatitis (Eczema) Basics Part 1

Atopic dermatitis (AD) is a chronic skin disorder that causes dry, itching, and inflamed skin. The rash of atopic dermatitis comes and goes.

The term eczema is sometimes used to describe atopic dermatitis. Eczema refers to inflamed, itching skin from a variety of causes. Atopic dermatitis is the most common type of eczema.

Atopic dermatitis is very common, affecting 10-15% of people. The severe itching and irritation during flare-ups can be extremely bothersome. The resulting scratching can result in raw skin and skin infections.

Fortunately, most cases of atopic dermatitis respond well to treatment.

What are the symptoms of atopic dermatitis?

The most obvious symptoms of atopic dermatitis are intense itching, along with red, dry skin that is sometimes scaly.

The worsening of atopic dermatitis symptoms is referred to as a “flare”. An atopic dermatitis flare can be triggered by a variety of factors (see below).

The appearance of atopic dermatitis varies tremendously from person to person. Most people with atopic dermatitis experience a short-term flare for a few weeks (acute), during which the skin looks red, raised, and cracked.

Between flares, the skin may appear normal or slightly dry. If the rash lasts a long time (chronic), the skin may start to change appearance, becoming thicker and darker. These patches of thickened skin take longer to respond to treatment.

The appearance of atopic dermatitis also tends to vary depending on the age of the person.

Atopic Dermatitis in Infants

Children less than one year old often have atopic dermatitis widely distributed over their body. The skin is usually dry, scaly, and red. The baby may scratch the skin, leading to scratch marks. The cheeks of infants are often the first place to be affected.

The diaper area is frequently spared because the moisture retained by the diapers prevents the skin from drying.

Atopic Dermatitis in Toddlers

As children reach 2 to 3 years old, atopic dermatitis becomes more localized to areas such as the outer part of the joint, including the front of the knees, outside elbows, and top of the wrists. Older children are also more capable of a vigorous scratch, creating very red and inflamed areas.

Atopic Dermatitis in School-age Children

As children reach school age, atopic dermatitis tends to migrate to the part of the joint that flexes, such as the insides of the elbows and knees. atopic dermatitis may also start to appear on the eyelids, earlobes, neck, and scalp.

School-age children may develop itchy blisters on the fingers and feet known as dyshidrotic or vesicular dermatitis (pompholyx).

Atopic Dermatitis in Adults

Adults with atopic dermatitis tend to have the rash localized to specific areas, particularly the hands, feet, eyelids, back of the knees, and insides of the elbows. However, the skin elsewhere on the body may feel dry and prone to itching.

Atopic dermatitis that starts in infancy often improves by the time the child is 5 years old and usually resolves by the teenage years. However, many people endure atopic dermatitis and need to manage it throughout their lives.  Stay tuned as I will address the causes and treatments in next week’s post.

By: Kirk D. Saddler, M.D.

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