Dear Doctors: I got a few patches of itchy, red skin on my arms six months ago. My doctor says it’s atopic dermatitis, but the cream he gave me isn’t helping. My friend says it’s eczema, which she also has. She let me try her prescription cream, and it got better. Does that mean I have eczema?
Dear Reader: Your physician and your friend are using different words, but they’re actually referring to the same condition.
Atopic dermatitis is another name for the most common form of eczema. Someone with atopic dermatitis has patches of dry, inflamed and usually itchy skin, which can appear anywhere on the body. It is estimated that more than 16 million people in the U.S. have atopic dermatitis, with close to one-third of those cases considered to be moderate or severe.
The basics of the condition are found in the name. “Derm” refers to the skin, and the suffix “itis” denotes inflammation. The word “atopic” indicates a genetic predisposition to an allergic response. Although the condition typically arises during childhood, it can appear at any stage of life. It’s not contagious, and it can’t be spread from person to person, even through direct physical contact.
Symptoms of atopic dermatitis can vary, but the reddened and itchy skin you’re experiencing is common. Additional signs include inflammation; localized swelling; thickening of the skin; dry, scaly or cracked skin; and a rash. In those with darker skin, the condition may appear as concentrated areas of small, raised bumps. Because the itch of this type of eczema can be relentless, the skin is easily damaged from repeated scratching. This causes the rash to weep or develop crusting, which leaves the person vulnerable to infection.
For genetically susceptible individuals, environmental factors such as cold air, hot showers, allergens, rough fabrics, fragrances and other household irritants can act as triggers for the condition. Stress is also a known trigger.
Due to the hypervigilance of their immune response, someone with atopic dermatitis has an increased risk of developing hay fever or asthma. Researchers have also found a link between this form of eczema and an increased susceptibility to food allergies. Unfortunately, there is no cure at this time. Instead, treatment focuses on managing symptoms, preventing infection and improving quality of life.
It’s important that you keep your skin well-moisturized. Use creams and lotions that are free of potential irritants, such as alcohol, dyes, fragrances or exfoliants. A humidifier to add moisture to the home also can help. When needed, medicated creams that include a topical steroid are prescribed to manage itching and inflammation. However, thinning skin is a side effect of topical steroids, which leaves the area vulnerable to injury. In that case, creams with a calcineurin inhibitor, which blocks a step in the inflammation process, can be a good alternative. Take care to avoid extremes in temperature, including while bathing, and never scrub your skin too hard or too long. Try to become aware of potential cause and effect when it comes to your eczema triggers. This can help you to better manage the condition.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.
ASK THE DOCTORS
EVE GLAZIER, M.D., AND ELIZABETH KO, M.D.
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