Atopic dermatitis, sometimes called eczema, is an allergic skin disorder which affects approximately 1% to 3% of all children and about 27% of infants born to mothers who themselves have an allergic disease. Eight percent of children with atopic dermatitis develop symptoms before the age of one year, but fortunately, about one-half of these children become symptom-free by the age of two years. The dermatitis of the other half may not clear until late adolescence, although a small fraction never clear completely. If atopic dermatitis makes its first appearance in a child who is over one year old, the possibility of early clearing is less likely.

Symptom Diagnosis

Itching, sometimes intense, is the hallmark symptom. With time, the lesions tend to scale and flake and, if bacterial or viral infection is introduced by scratching, the affected lesions will ooze.

In infants, atopic dermatitis commonly appears on the face and in the creases behind the ears, at the elbows, behind the knees, and at the buttocks. When the face is involved, a prominent fold across the lower eyelids, called a Dennie's line, may appear. In children, the skin of the outer arms and legs may also be affected.

Children and adults who have atopic dermatitis will develop a white, raised wheal when their skin is firmly stroked in an affected area by a tongue depressor or the back of a fingernail. This is termed white dermatographism (white writing), and is a maneuver used by a physician when the diagnosis for atopic dermatitis is uncertain.

Other diagnostic tests which are helpful — when there is no family history of allergies and the child does not have asthma or nasal allergies — include a blood test for the quantity of circulating IgE antibodies, which are elevated in 80% of atopic dermatitis patients, and allergy skin tests. The latter are useful in identifying foods or inhaled substances such as house dust, dust mites, animal dander, or pollen to which the patient is allergic, and which may be responsible for flare-ups of skin lesions.

Food and Environmental Triggers

If the patient reacts significantly to foods when skin is tested, those foods should be eliminated from the diet and the patient or family should observe the effect of their removal. Should the skin improve and the itching lessen markedly, it would be advisable to re-introduce the suspect food or foods one by one while watching for the return of original symptoms. If a food or foods are clearly the culprit, they should be removed completely from the diet. If the food is an essential one — such as milk in infants — your physician will be able to recommend non-allergic substitutes. If environmental factors are suspected, they should be dealt with similarly.

Managing Symptoms

Itching can be minimized by bathing in tepid water and using unscented soap, patting (not rubbing) the skin to partially dry it, and applying a water-in-oil cream or lotion immediately. Steroid creams or ointments are useful for application to severely affected areas, but should not be applied to the face. Certain antihistamines are very helpful in relieving itching, and for children older than 12 years, non-sedating, long-acting antihistamines are especially desirable.

To improve symptoms, fingernails should be kept short and clothing fabrics should be soft and porous when possible. Laundry detergents should be mild and free of perfumes. If there is oozing from the affected skin areas, the patient should consult a physician, as antibiotic treatment may be necessary.

Long-Term Outlook

A 21-year follow-up study showed that, of children who developed atopic dermatitis in infancy, about 30% had no skin problems and had not developed other allergic disorders. Twenty-one years later, 35% had no skin lesions but had developed asthma and/or hay fever; 20% still had atopic dermatitis; and only 15% had persistent dermatitis plus asthma or hay fever. However, it is not clear how diligently these patients followed recommendations. It is likely that strict observance of dietary, environmental, and therapeutic measures could produce even better long-term results.

Your allergist can provide you with more information on atopic dermatitis.

Adapted from American Academy of Allergy, Asthma and Immunology Tip 15.

If you have any questions, contact our office: Omaha: 402-391-1800 Lincoln: 402-464-5969