The Itch That Rashes
by Joan Csaposs

A topic dermatitis, also known as AD, eczema, or atopic eczema, is a common skin condition that most commonly affects children, but may occur in an individual who was not affected in childhood. This condition is more that just "sensitive skin." AD is often called "the itch that rashes." If there is no itch, there is no rash. Nearly 60 percent of people affected by this condition have it by age one, and 85 percent of those affected have it by age five. Early onset is usually an indication of more severe disease. AD is characterized by periods of remission and exacerbation. The incidence of AD has been on the rise over the last several decades, including in industrialized countries.

Young children from two months to two years can appear with an itchy red rash on the cheeks, the area around the mouth, scalp, and the tops of the feet, elbows and knees. Such a child is itchy, scratchy, irritated and unhappy. Older children from two to twelve years usually have the rash on the front of the elbows, behind the knees, neck, wrists and ankles. The rash on adults with AD may appear like that on an older child or be confined to the hands or eyelids or be scattered and patchy over the body. The skin on both older children and adults may show signs of "lichenification": raised and thick from constant scratching. In all cases, the symptoms wax and wane.

Seventy percent of people with AD have a family history of the illness or of asthma, hay fever or seasonal allergy. The conditions of some 80 percent of those affected resolve by age 12, although adults may experience a relapse of the disease.

Dry skin affects everyone with AD. A defect in their skin prevents it from staying moist. Moist skin is soft, flexible and strong, while dry skin is brittle and fragile. Dry, scaly, rough and tight skin cannot properly perform the skin's main function as a barrier against dirt, germs, and chemicals.

As mentioned, symptoms of AD come and go, so the best treatment is to learn what triggers the condition in each individual and avoid those triggers--the substances and conditions that promote irritation, dryness and/or itch.

Most people are worse in the winter months, especially in the north with indoor heating and dry air. Too many hot baths and too much soap only make matters worse. The best way to wash is with a mild soap without fragrance (Dove, Cetaphil, Oil of Olay--not Ivory), warm water, and to go easy with the washcloth. After bathing it's important to dry the scalp, face, armpits and groin, and then apply a thin coat of plain Vasoline or mineral oil to the wet skin and dry off the excess (the Vasoline or mineral oil will trap the water that is in the skin from bathing).

Some people with AD are worse during the summer months, especially on hot and humid days that make us sweat more. On such days it's important to avoid overdressing, and to seek out a cool and well-ventilated environment.

Examples of irritants that can aggravate itching, burning, redness or dryness of the skin are: fragrances, wool solvents and cleaners, some cosmetics, detergents, soap, perfumes and sweat. Those people with AD who are affected by allergies must learn to avoid and/or control their exposure to allergens--dust mites, cats and dogs, grasses and trees, feathers, etc. Stress reduction techniques may be helpful in controlling the symptoms of AD--providing the person is able to recognize stress and can do something to reduce it.

The skin of individuals with AD is fragile and predisposed both to itching and to skin infections more than is the general public. Moisturizing and avoidance of triggers can decrease the incidence of infection, but when infections take hold, they need to be treated promptly by a health care provider.

The first treatment for someone with AD whose symptoms flare up is topical corticosteroids of appropriate strength, to reduce inflammation. Topical immune modulators may also be ordered by a health provider, as may be oral antibiotics if the skin is infected. Once the infection is under control, one to six teaspoons of bleach to the bath water helps to control the bacteria on the skin. Oral antihistamines--especially those that are sedative--will help a person to sleep and not scratch. A dermatologist should be consulted in severe cases.

Atopic dermatitis is a common condition that affects individuals over their lifetimes. The disease is treatable and manageable with time and effort and the understanding of family and loved ones.

Joan Csaposs is a family nurse practitioner with Upper Hudson Valley Dermatology.