Atopic dermatitis is the most common type of dry, itchy skin known as eczema. It affects 10-20 percent of kids and from 1-3 percent of adults.

Patients may scratch uncontrollably leading to redness, swelling and cracking of the skin, with crusting and scaling, and even “weeping” of clear fluid. Patches of the affected skin may be widespread and the constant scratching can lead to skin damage, secondary infection and loss of sleep.

In kids, we often see this condition develop in the first year of life, and it develops in 80 percent of those affected before age 5. In infants, itchy patches are often noted on the scalp, forehead, and cheeks. Many of these younger children get better with time, but it may be a clue for the “allergic march”, with a risk for the development of allergy and asthma. Therefore, we carefully monitor for any associated wheezing and persistent congestion, and at times, test for associated food allergies, including milk products, nuts and shellfish. Controlling asthma symptoms and environmental allergies and hay fever will also help clear up the skin. If the condition doesn’t resolve early on, a childhood phase develops with skin involvement that usually appears on the inside of the elbows or the back of the knees. We often see this in older children and teens, and they may also show patches on the face, hands, feet, wrists and ankles, and neck and upper chest. With time, the patches may become discolored, scaly and thick, as well as emotionally distressing. Fortunately, the itchy skin tends to improve with time, but it may be a lifelong condition for those severely affected.  For example, hand eczema is an especially bothersome form of dry skin that can become chronic and interfere with everyday activities. The use of prescription ointments and creams with frequent use of moisturizers is helpful, but it is especially important to avoid harsh soaps and irritating cleansers, and even use gloves for protection. This presents a good example of the effectiveness of combining of good medical treatment with environmental control.

While the treatment and control of atopic dermatitis may be challenging, it is very rewarding to see patients improve when we educate them and their families about controlling the condition. I recently attended a medical conference with lectures from a noted dermatologist who taught us that the use of bleach scrubs for certain challenging cases is helpful, and I’ve had some good success with this treatment. By working together with patients and their families, we look to identify and avoid allergen and environmental triggers, and develop an effective long-term treatment and prevention plan, including the use of approved corticosteroid creams and ointments, breaking the itch cycle with non-sedating antihistamines, and the use of aggressive moisturization. We can make a difference and stop the “itch cycle” in our patients with eczema.


Adapted from the pamphlet:

Eczema/Atopic Dermatitis, a 2009 publication of the American Academy of Dermatology.