Eczema, also called atopic dermatitis, is a common, chronic, relapsing, inflammatory skin condition in children as well as adults. It is especially common in infants and young children and in fact is the most common chronic skin condition in children with a lifetime prevalence of 17%. It starts before the age of 5 years approximately 90% of the time. Eczema is associated with a dysfunction of the skin barrier, causing excessive water loss from the skin. There is also immune dysregulation, which potentiates inflammation and can result in more frequent skin infections with staph bacteria and occasionally with other organisms such as the herpes virus. A good source for further information is the National Eczema Association.
Symptoms
Symptoms include itching and thickened, red skin on many parts of the body. It tends to affect the face and outside of the arms in infants and young children. In older children and adults, the inner part of the elbows as well as the area behind the knees is frequently involved. It may be mild or severe, especially in young children. It may involve multiple other parts of the body.
Eczema and allergies
Eczema is frequently associated with allergies. In fact, eczema in infancy is a common risk factor for developing food allergies. Allergens in the environment, such as pet danders and dust mite may also cause flares. Infants and young children with eczema are at increased risk of developing asthma.
Treatment
The treatment of eczema requires a comprehensive management plan with attention to patient education. Skin testing to look for allergic triggers is occasionally needed.
Basic management consists of at least 4 components:
- Regular (daily) bathing with warm water,
- Application of a thick moisturizer on a regular basis, especially immediately after bathing. Click here for more information about moisturization from the National Eczema Association.
- Avoidance of any known irritants and allergens.
- Anti-inflammatory agents, both steroidal and nonsteroidal (e.g.Elidel, Protopic, Eucrisa, VTAMA, Opzelura) applied directly to the skin. Click here to see a handout regarding prescription medicine from the National Eczema Association.
In some cases, other treatment modalities may be needed including biologics and/or allergy shots. There are now several biologics approved for the treatment of atopic dermatitis, with Dupixent being approved all the way down to infants 6 months of age.