Atopic dermatitis is the most common chronic form of dermatitis, itchy skin condition that is very common in children but may occur at any age or people having atopic tendencies. This means they may develop any or all of three closely linked conditions; atopic dermatitis, asthma and hay fever (allergic rhinitis). It is also known as eczema and atopic eczema. Often these conditions run within families with a parent, child or sibling also affected. Atopic dermatitis is not contagious! It arises because of a complex interaction of genetic and environmental factors. These include skin irritants, the weather, temperature. 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. However, ongoing researches have proved that eczema can be cured anytime in the foreseeable future with very effective treatments. Several treatments are available that will control the eczema so the skin looks and feels normal.
In general topical treatments are used first as they are effective for most patients if used correctly and have the fewest side effects. Most people with eczema use topical treatments (lotions, creams and ointments). When the surface of skin is inflamed, cracked or raw, many of these sting or burn when first applied. This irritation will lessen as the eczema gets cured. Oral medications may be offered to those with severe or treatment-resistant eczema. Although these are usually effective, they have side effects and risks that make them unsuitable as first line of treatment. Lotions and creams provide moisture to the skin and help prevent further water loss. Creams are most commonly used. Lotions are easy to apply but evaporate quickly and may not be oily enough.
Topical steroids are the mainstay of treatment for mild to moderate eczema. They are very effective and safe if used correctly, that is, use correct strength of steroid accordingly as the severity of the eczema changes. Yet, many people are concerned about potential side effects from topical steroids. Mild eczema is likely to respond to low potency topical steroids within a few days, often with complete clearance of eczema within one or two weeks. Moderate eczema may require more potent topical steroids for at least two weeks before improving and may require several weeks of treatment before clearing. Severe eczema may show only partial improvement with potent topical steroids alone even after several months of use.
As eczema tends to be persistent, most people will have to use topical steroids for many years. If used continuously topical steroids may lose their effectiveness after a few weeks (this is known as tachyphylaxis). If tachyphylaxis occurs, treatment needs to be tailored to the individual patient. Changing to a different topical steroid of the same strength can be helpful. Moderate and severe eczema are more difficult to manage. The eczema may not have completely cleared with a potent topical steroid after three to four weeks and then it seems to lose its efficacy. Treatment of infection, if present, may again make the topical steroid effective. A stronger topical steroid or an additional treatment such as phototherapy may be required. Phototherapy or ultraviolet (UV) treatment is reserved for severe eczema has potential side effects. It involves controlled exposure to UV-B and/or UV-A for a few minutes two to three times each week. A treatment course may continue for several months.
Antibiotics are sometimes very important in the management of atopic dermatitis, most often when there are signs of bacterial infection. The antibiotics are mostly given orally, penicillin derivatives are usually prescribed, or erythromycin, those allergic to penicillin. On discontinuing the oral antibiotic, the patient may suffer another flare so antibiotics may be required for several months. There is a low risk of side effects from such treatment. Antihistamines are sometimes helpful in stabilizing atopic dermatitis and may reduce the itch. They tend to be used more commonly in children.
Despite the potential long-term side effects of these agents, most patients who take them for severe eczema are satisfied with the result as it frees them from otherwise disabling eczema.