Eczema / Atopic Dermatitis


Eczema (pronounced "EK-zema") , also known as atopic dermatitis, is one of the most common skin diseases in the United States. The condition affects nearly 9% of the overall U.S. population and 15% of children. Eczema falls into a category of diseases called atopic, a term originally used to describe the allergic conditions asthma and hay fever.

Eczema almost always begins in childhood, usually during infancy. Its symptoms are dry, itchy, scaly skin, cracks behind the ears, and rashes on the cheeks, arms, and legs. It alternately improves and worsens. It’s seldom present at birth, but it often comes on after six weeks.

The skin’s main function is to provide a barrier against dirt, germs and chemicals from the outside. We don’t notice this barrier unless it gets dry, and then it’s scaly, rough and tight. Dry skin is brittle — moist skin is soft and flexible. People with eczema have a defect in their skin and it won’t stay moist. It is especially bad in winter when the heat is on in the house and the humidity drops. Other things that dry the skin are bathing without proper moisturizing.

Eczema is a very itchy rash. Much of the skin damage comes from scratching and rubbing that cannot be controlled.

During "flare-ups," open weeping or crusted sores may develop from the scratching or from infections. Eczema can also be a sign that other allergic conditions are present, such as food allergies, allergic rhinitis and even asthma. Skin symptoms may get worse after eating.

Eczema is not contagious. Research indicates that atopic diseases like Eczema are genetically determined, inherited from one’s parents. A child with one parent who has an atopic condition has a one-in-four chance of having some form of atopic disease. If both parents are atopic, the child has a greater than one-in-two chance of being atopic.


Trigger factors may be different for different people. Most get worse when they get a cold or other infection. Most have worse problems in the winter; but others simply can’t stand the sweating during hot, humid summer weather. Let’s look at the trigger factors that seem to affect every child with eczema.

Irritants are any of the substances outside the body that can cause burning, redness, itching or dryness of the skin. The challenge: Avoid irritating substances.

Stress. Emotional stress comes from many situations. People with AD often react to stress by having red flushing and itching. Special problems for children with AD include frustration, anger or fear, such as when getting the "silent treatment" from a parent. And, of course, AD itself, and its treatments, are a source of stress! The challenge: Recognize stress and reduce it.

Heat and sweating. Most people with atopic dermatitis notice that when they get hot, they itch. They have a type of prickly heat that doesn’t occur just in humid summertime but any time they sweat. It can happen from exercise, from too many warm bedclothes or rapid changes in temperature from cold to warm.

Infections. Bacterial "staph" infections are the most common, especially on arms and legs. Such infections might be suspected if areas are weeping or crusted or if small "pus-bumps" are seen. Herpes infections (such as fever blisters or cold sores) and fungus (ringworm or athlete’s foot) can also trigger AD. If some lesions look different, ask your doctor. If they turn out to be infected, they can be treated with antibiotics. Recognize and treat pustules or crusted lesions.

Allergens. Allergens are materials such as pollen, pet dander, foods, or dust, that cause allergic responses. Allergic diseases such as asthma and hay fever, which flare quickly, are easy to tie to allergens. Itching and hives appear soon after exposure to these airborne allergens and last only briefly. The slower, continuing, chronic eczema of AD may be more difficult to tie to specific allergens. Foods, dust mites and pets can trigger eczema in many patients. Avoidance of foods is not recommended with out proper diagnosis. If a food allergy is diagnosed most all patients react to only 1-2 food families. It is extrodinarly rare to have an allergy to a large number of foods.

Allergy diagnosis (click here to learn more)
A skin test, made by scratching the skin with the suspected allergen, is helpful if the test is negative (indicating that the particular food will not affect the patient). If the scratched area becomes inflamed, the test is considered positive. Unfortunately, positive results are difficult to interpret and are falsely positive 50% of the time and possibly more. Positive tests provide a clue to a possible allergy but need to be confirmed. Additionally, because the skin of AD sufferers is so sensitive, simply scratching it can cause inflammation, making the likelihood of a false-positive skin test even higher.

A blood test is another type of test to detect food allergies. Blood tests, also, have a false positive rate higher.

These tests are difficult to interpret and requires experience and training to make an accurate diagnosis. Any positive test must be confirmed by a challenge. There is a great likely hood that a positive test will not cause any symptoms so avoiding a food may not help you in any form.

Can sufferers of AD live normal lives?
Yes! People with AD do not have to be limited by their disease. It can be controlled by prevention, medication, and careful adherence to a treatment program consisting of: skin hydration, itch control, inflammation control.