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Medical Dermatology >> Eczema


Many of you have heard the terms eczema and dermatitis. They are interchangeable and both describe skin that is inflamed. The skin may be inflamed for a number of reasons involving irritation such as exposure to harsh soaps or chemicals or the skin may be inflamed by contact with something you are allergic to such as poison oak.

Whenever dermatologists refer to eczema we typically mean a common, specific skin condition called atopic dermatitis. Atopic dermatitis usually occurs in people who have a personal or family history of asthma, hay fever, or eczema. Patients with atopic dermatitis have extremely sensitive and excessively reactive skin with a considerably lower threshold for the sensation of itching. Their skin is usually dry and has an impaired protective barrier to the environment. This makes their skin even more easily irritated that causes a worsening of their itching and their rash.

Atopic dermatitis has 3 phases in life. The initial phase starts during the first few months of life and typically affects the face as well as the extensor or outside surfaces of the arms and legs. The skin is red, scaly, sometimes with oozing and very itchy. Those infants are often very fussy, don’t sleep well, and may have difficulty with milk and some other foods.

The second childhood phase includes the flexural regions such as the inside of the elbows and wrists, behind the knees, and the neck. The epidermis is drier and thicker and is extremely itchy and may create secondary bacterial infections.

The third adult phase usually appears as a dry, itchy, sensitive rash on the hands that are sensitive and easily irritated.

All phases of atopic dermatitis need treatment of the dryness of the skin with regular and routine moisturization. The use of prescription topical steroid creams and ointments as well as nonsteroid anti-inflammatory creams and ointments are a mainstay of the treatment. Often oral antihistamines are needed to decrease the strong sensation of itching, and oral antibiotics are required when infection is present. In severe cases other oral medications and ultraviolet light therapy may be needed.

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