Atopic Dermatitis is a common skin disease in children, although it can happen at any age. It is so common that people have given it a few names: Eczema (most common name), Dermatitis, as wel as Atopic (a-top-ic) Eczema. To avoid confusion, we’ll use the medical term atopic dermatitis.
Children often get atopic dermatitis (AD) during their first year of life. If a child gets AD during this time, dry and scaly patches appear on the skin. These patches often appear on the scalp, forehead, and face. These patches are very common on the cheeks.
No matter where it appears, AD is often very itchy. Infants may rub their skin against bedding or carpeting to relieve the itch.
In children of all ages, the itch can be so intense that a child cannot sleep. Scratching can lead to a skin infection.
Because AD can be long lasting, it is important to learn how to take care of the skin. Treatment and good skin care can alleviate much of the discomfort.
AD usually occurs in people who have an ‘atopic tendency’. This means they may develop any or all of three closely linked conditions; atopic dermatitis, asthma and hay fever (allergic rhinitis). Often these conditions run within families with a parent, child or sibling also affected. A family history of asthma, eczema or hay fever is particularly useful in diagnosing atopic dermatitis in infants.
Atopic dermatitis arises because of a complex interaction of genetic and environmental factors. This can lead to the skin more susceptible to irritation by soap and other contact irritants, the weather, temperature and non-specific triggers.
There is quite a variation in the appearance of atopic dermatitis between individuals. From time to time, most people have acute flares with inflamed, red, sometimes blistered and weepy patches. In between flares, the skin may appear normal or suffer from chronic eczema with dry, thickened and itchy areas.
The presence of infection or an additional skin condition, the creams applied, the age of the person, their ethnic origin and other factors can alter the way eczema looks and feels.
There are however some general patterns to where the eczema is found on the body according to the age of the affected person.
Atopic dermatitis affects 15–20% of children but is much less common in adults. It is impossible to predict whether eczema will improve by itself or not in an individual. Sensitive skin persists life-long. A meta-analysis including over 110,000 subjects found that 20% of children with atopic dermatitis still had persistent disease 8 years later. Fewer than 5% had persistent disease 20 years later. Children who developed AD before the age of 2 had a much lower risk of persistent disease than those who developed AD later in childhood or during adolescence.
It is unusual for an infant to be affected with atopic dermatitis before the age of four months. They may suffer from infantile seborrhoeic dermatitis or other rashes prior to this. The onset of atopic dermatitis is usually before two years of age although it can manifest itself in older people for the first time.
Atopic dermatitis is often worst between the ages of two and four but it generally improves after this and may clear altogether by the teens.
Certain occupations such as farming, hairdressing, domestic and industrial cleaning, domestic duties and care-giving expose the skin to various irritants and allergens. This aggravates atopic dermatitis. It is wise to bear this in mind when considering career options — it is usually easier to choose a more suitable occupation from the outset than to change it later.
It nearly always requires:
In some cases, management may also include one of more of the following:
Longstanding and severe eczema may be treated with an immunosuppressive agent.
If you or your child is experiencing atopic dermatitis, schedule an appointment with Dr. Ginsburg to learn more about treatment options. Fill out the form below, or call us at (205) 592-4880