Atopic Eczema

Atopic eczema, the most common form of eczema, affects an estimated 15 million people. It manifests itself as an inflammation of the skin, which tends to flare-up from time to time, usually starting in early childhood. Typical skin symptoms include dryness, thickening, and even scarring. There is no 'cure', but treatment will usually control or ease symptoms. The predisposition for atopic eczema is an inherited condition that is usually triggered by an allergic reaction. This chronic condition is not contagious and often begins in infancy as a rash on the scalp, face, or upper extremities of the baby. Atopic eczema is most commonly located in areas where the body bends or experiences contact thus creating friction that can cause eczema.

The word 'atopic' describes people with certain 'allergic' tendencies. However, atopic eczema is not just a simple allergic condition. People with atopic eczema have an increased chance of developing other 'atopic' conditions such as asthma and hay fever.

Atopic eczema affects each person differently, both in terms of onset and severity of symptoms. In infants, atopic eczema typically begins around 6 to 12 weeks of age. It may first appear around the cheeks and chin as a patchy facial rash, sometimes progressing to red, scaling, oozing skin, which can become infected. Once the infant becomes more mobile and begins crawling, exposed areas such as the knees and elbows may also be affected. An infant with atopic eczema may be restless and irritable because of the itching and discomfort. Many infants improve by 18 months of age, although they remain at greater than normal risk for dry skin or hand eczema later in life.

In childhood, the rash tends to occur behind the knees and inside the elbows, on the sides of the neck, and on the wrists, ankles, and hands. Often, the rash begins with papules that become hard and scaly when scratched. The skin around the lips may be inflamed, and constant licking of the area may lead to small, painful cracks. Severe cases of atopic eczema may affect growth, and the child may be shorter than average.

Atopic eczema most often affects infants and young children, but it can continue into adulthood or first show up later in life. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, which are followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic eczema enter into a permanent remission of the disease when they get older, although their skin often remains dry and easily irritated. Environmental factors can activate symptoms of atopic eczema at any time in the lives of individuals who have inherited this disease trait.

The disease may go into remission. The length of a remission varies, and it may last months or even years. In some children, the disease gets better for a long time only to come back at the onset of puberty when hormones, stress, and the use of irritating skin care products or cosmetics may cause the condition to flare.

Although a number of people who developed atopic eczema as children also experience symptoms as adults, it is unusual (but possible) for the disease to show up first in adulthood. The pattern in adults is similar to that seen in children; that is, the disease may be widespread or limited. In some adults, only the hands or feet may be affected and become dry, itchy, red, and cracked. Sleep patterns and work performance may be affected, and long-term use of medications to treat the condition may cause complications. Adults with atopic dermatitis also have a predisposition toward irritant contact dermatitis, especially if they are in occupations involving frequent hand wetting, hand washing, or exposure to chemicals. Some people develop a rash around their nipples. These localized symptoms are difficult to treat, and people often do not tell their doctor because of modesty or embarrassment. Adults may also develop cataracts that are difficult to detect because they cause no symptoms. Therefore, the doctor may recommend regular eye exams.

Atopic eczema affects males and females equally and accounts for 10 to 20% of all referrals to dermatologists. It is estimated that 65 percent of patients develop symptoms in the first year of life, and 90 percent develop symptoms before the age of 5. Onset after age 30 is less common and often occurs after exposure of the skin to harsh conditions. People who live in urban areas and in climates with low humidity seem to be at an increased risk for developing atopic dermatitis.

About 10% of all infants and young children experience symptoms of the disease. Roughly 60 percent of these infants continue to have one or more symptoms of atopic dermatitis even after they reach adulthood. This means that more than 15 million people in the United States have symptoms of the disease.

It is estimated that one in three people are affected by atopic eczema. However, the development of atopic eczema in a person who has a predisposition to it is likely to be greatly influenced by the environment.

Causes of Atopic Eczema

It is thought that people with atopic eczema are sensitive to certain allergens in the environment, which are harmless to others. In atopic eczema, there is an excessive reaction by the immune system producing inflamed, irritated and sore skin.

Atopic eczema occurs when an individual inherits the capacity to produce excessive antibodies called immunoglobulin E (IgE). These antibodies are particularly aggressive and attack foreign substances that enter the body. Eczema, asthma and allergic rhinitis are the most common atopic conditions. These antibodies exist to defend the body against attack. In atopic eczema the large number of antibodies are encountering alien substances or allergens and reacting to them in the form of inflammation and itchiness. These allergens can include dust, pollen, chemicals, food, or drink.

The role of allergies to dust mites, pets, and food in atopic eczema is controversial. In a high proportion of sufferers, the application of a dust mite allergen to the skin will worsen their condition. The condition of a child may improve in a hospital where mite counts are low. It is thought that environmental exposure and lifestyle may be as much a factor in the development of childhood eczema as genetic factors. With atopic eczema, it is believed that a predisposition to the condition is inherited and then triggered by allergens.

In the industrialized world, allergies are a growing problem. The changes in society which may be contributing to the incidence of allergies include: the levels of nitrogen oxides (from diesel engines), ozone in the air, central heating, double insulation in homes, soft furnishings, fumes from gas cookers, sprays, and cigarettes.

The role of food allergy is controversial. The most reliable means of establishing a food allergy is to keep a food diary and then to eliminate the suspected item from the diet. If the eczema improves, the suspect food can be re-introduced. If the condition worsens again, this provides reasonable proof of the cause.

In the past, it was thought that atopic eczema was caused by an emotional disorder. However, we now know that while emotional factors such as stress can exacerbate the condition, but they do not cause it.

Atopic eczema appears to result from a combination of hereditary and environmental factors. Research indicates that the disease is associated with other so-called atopic disorders such as hay fever and asthma, which many people with atopic eczema also have. In addition, many children who outgrow the symptoms of atopic eczema go on to develop hay fever or asthma. Although one disorder does not cause another, they may be related, thereby giving researchers clues to understanding atopic eczema.

Trigger factors for atopic eczema may include soap, harsh chemicals, heat and humidity, stress, certain foods (most common offenders include eggs, milk, wheat, soy protein, and peanut). Many of these ingredients can turn up in unusual places, such as all-natural soaps, makeup, creams, or lotions. Inhalant allergens such as house dust mites, pets, pollen, and cut grass are also triggers that can cause eczema. Atopic eczema is normally associated with a family history of asthma or allergic rhinitis accompanied by chronic or recurrent dry, extremely itchy, inflamed lesions.