Itchy Skin: Dealing With Eczema (Atopic Dermatitis)
By Nathan Rendler, MD
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.
Hives in Children
By Nathan Rendler, MD
Hives, or urticaria, are localized pink swellings on the skin that are produced by histamine, a chemical released into the skin from the mast cells that lie along our blood vessels. They are usually itchy, and may occasionally burn or sting. They vary in size and are quite common in children. Up to 10-20 percent of the population will have at least one episode in their lifetime, and fortunately, most resolve quickly, but some may last for days, weeks or even longer. Occasionally, they may be severe enough to require an emergency visit for associated problems with severe facial swelling with trouble swallowing, wheezing and trouble breathing, severe abdominal pain or severe joint pain/swelling.
By definition, acute hives last less than 6 weeks, and oftentimes, a trigger can be identified and eliminated. Common foods like milk, berries, eggs, tomatoes, shellfish, nuts and chocolate may cause hives.
Any of the over the counter medications can cause hives, and a common cause that pediatricians see involves an allergic reaction to antibiotics, like penicillin and sulfa drugs. We also see hives related to bee stings, viral upper respiratory tract infections, hepatitis and occasionally from bacterial and fungal infections.
Hives that last longer than 6 weeks are considered chronic and are much rarer. It is usually much harder to identify the cause and a referral to a dermatologist or allergist may be needed, with additional blood tests or skin biopsy for diagnosis.
Other physical causes may produce hives, including sensitivity to cold, heat, exercise and pressure. Some healthy patients may even develop hives from firm stroking or scratching of the skin, and though recurrent, these causes tend to be self-limited.
Most patients respond to a short course of daily non-sedating antihistamines, but occasionally a longer course of treatment combining the use of two antihistamines may be needed, as well as the use of steroids, or even an injection of epinephrine in more severe cases. We counsel our patients that the best treatment remains working together to identify an underlying cause and eliminating it whenever possible.
Adapted from the educational pamphlet: Urticaria-Hives A 2005 publication from the American Academy of Dermatology.