Atopic dermatitis (AD), also known as allergic eczema, is a chronic, inflammatory condition that leads to recurrent itching and skin rashes. AD has a tendency to affect patients with an allergic predisposition and may be the first of many allergic diseases to affect a child such as food allergy, asthma, and allergies of the nose and eyes. AD occurs in up to 1 in 5 children. Symptoms can resolve in childhood, but this skin condition can extend into adulthood. Patients with AD have an impaired skin barrier that results in moisture loss more easily than a person without AD. In affected individuals, food and/or environmental allergies (pollens, dust mites, cockroaches, pets, and molds) are common triggers for exacerbations of their eczema.
AD is typically diagnosed by a healthcare professional based on the medical history, family history and physical examination. All individuals with atopic dermatitis should undergo testing for allergic triggers. An allergist typically screens for allergies with skin prick testing. Skin prick testing is a quick, safe method that can be performed to evaluate for food and/or environmental triggers for AD. The results are typically obtained within 15-20 minutes after the test is placed on the skin. Individuals that are unable to stop their antihistamines or who have significant skin involvement may undergo laboratory testing, however results obtained by skin testing tend to be more accurate. Laboratory tests for food and environmental allergies typically return in 3-7 days.
Hydration of the skin with a topical moisturizer is the most important treatment for. Topical moisturizers are available over-the-counter at most pharmacies. Moisturizer may need to be applied multiple times per day to control atopic dermatitis in some individuals. Avoidance of particular allergic triggers such as foods identified on testing can be helpful. Some other tips for treatment of AD include avoiding hot water on the skin, use of dye/fragrance-free soaps for bathing, patting (not rubbing or scrubbing) the skin dry after bathing, and applying moisturizer immediately after bathing. To aid with itching, many patients with AD use oral antihistamines. For some patients, long-acting, less sedating antihistamines such as Claritin, Zyrtec, and Allegra can be helpful. However, some patients may use short-acting, more sedating antihistamines such as Benadryl to aid with acute episodes of itching. Flare-ups (patches or areas of the skin that become red, itchy and irritated) are usually treated with prescription topical steroid creams or ointments for a number of days until the flared patches are under better control. Avoidance of environmental triggers can certainly be helpful for patients with AD; however many environmental triggers can be unavoidable for patients. Allergen immunotherapy (also known as allergy shots) can be used as treatment against environmental triggers for AD. In many cases, this can alleviate symptoms, reduce the number of medications used for treatment, and reduce risk for asthma in younger children.
An allergist is a physician with specific training and expertise in the diagnosis and treatment of AD. An allergist can help identify environmental or dietary triggers and work with patients and their families in creating an effective and practical treatment plan. At Allergy Partners our physicians are committed to making sure that patients with eczema and other allergic conditions receive the highest quality medical care available.