Atopic eczema is a chronic, itchy skin condition that is very common in children but may occur at any age. It is also known as eczema and atopic dermatitis. Atopic eczema usually occurs in people who have an 'atopic tendency'. This means they may develop any or all of three closely linked conditions: atopic eczema, asthma and hay fever (allergic rhinitis). Often these conditions run within families, and a family history of asthma, eczema or hay fever is particularly useful in diagnosing atopic eczema in infants.
Atopic eczema arises because of a complex interaction of genetic and environmental factors. These include defects in skin barrier function making the skin more susceptible to irritation by soap and other contact irritants, the weather, temperature and non-specific triggers. Atopic eczema affects 15-20% of children but only 1-2% of adults. The onset of atopic eczema is usually before two years of age although it can manifest itself in older people for the first time. Atopic eczema is often worst between the ages of two and four but it generally improves after this and may clear altogether by the teens.
There is quite a variation in the appearance of atopic eczema 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.
Treatment of atopic dermatitis requires reduction of exposure to triggers when possible, regular use of moisturizers, and intermittent topical steroids. Self skin care includes avoiding hot showers, bathing or showering for less than 10 minutes, using a mild soap such as Dove, and moisturizing after each shower. In some cases, those with atopic dermatitis may benefit from topical calcineurin inhibitors, antibiotics, antihistamines, and light treatment. For longstanding and severe eczema, we may consider systemic medications.