Atopic dermatitis or atopic eczema is a chronic inflammatory skin condition that causes itching of the skin and chronic or recurrent skin lesions. Atopic dermatitis can significantly impair quality of life due to sleep disturbance, skin changes and scarring, and skin infections. Treatment may require topical or oral steroids which have potential side effects. Studies that have evaluated allergen avoidance measures as a means to PREVENT atopic dermatitis have not shown much benefit. However, new studies indicate that using inexpensive moisturizing emollients at a very young age may prevent eczema and perhaps even allergies in at risk children.
Atopic dermatitis is now felt to result from skin barrier defects. Many people with eczema have defects in a protein called filaggrin in the top layers of skin. This protein and lipid layers together help maintain a healthy skin barrier. The outer layers of skin are important to retain skin moisture and act as an effective barrier to environmental allergens and irritants. The question is whether or not enhancement of the defective skin barrier could prevent or delay the onset of atopic dermatitis. Emollients (hydrating agents) improve the skin barrier by providing extra lipids to the skin.
Recent studies have evaluated the benefit of early application of emollients to the skin of infants at high risk for developing atopic dermatitis and have shown positive results. In a pilot study done in the United States and in the United Kingdom, daily application of an emollient to the entire body surface, except the scalp, beginning by 3 weeks of age showed a reduction in the incidence of atopic dermatitis at 6 months of age. The emollients used in the US included sunflower seed oil with a high ratio of linoleic acid/oleic acid, Cetaphil cream, and Aquaphor ointment. Most parents preferred using a cream and there were no adverse effects noted from applying the moisturizers.
Allergen sensitization can occur through skin that is not intact and preventing the development of atopic dermatitis may reduce allergic sensitization. For example, studies have identified peanut allergen in dust in homes where peanuts are consumed and skin exposure to this allergen is believed to sensitize some infants and children with eczema to peanut. Thus, applying an emollient cream such as Cetaphil on a daily basis beginning shortly after an infant is born may prevent the development of atopic dermatitis and sensitization to allergens through the skin.
Once atopic dermatitis is established, use of emollients remains a mainstay of treatment. In addition, evaluation by an allergist and allergy testing can help identify environmental or dietary allergic sensitivity that may be triggering symptoms. Your Allergy Partners physician will work with you to develop an individualized treatment plan that includes avoidance of allergens and irritants and other skin care recommendations.