Eczema: Atopic Dermatitis
Eczema: Atopic Dermatitis
Diagnosis
Physicians are often able to diagnose eczema based on medical history and the characteristic appearance of the rash alone.
After a thorough family medical history and a personal history of allergy-related conditions is taken, physicians will typically examine the entire surface of the body to note the pattern, severity, and characteristics of the rash. The following criteria are considered basic grounds for a diagnosis of eczema:
- a pattern of itching and scratching
- a rash that increases and decreases in severity
- a rash that has a typical distribution of reddened, itchy patches
- a personal or family history of allergic conditions
- the condition lasts longer than six weeks.
Almost all people with eczema have dry skin, which makes the problem worse.
Blood tests may be done to check for levels of a type of antibody called IgE, which are often, but not always, elevated in people with eczema.
Your doctor may want to test the skin to see if it is hypersensitive to other substances. Though rarely required, a skin biopsy may be performed to rule out other causes of skin irritation.
Eczema begins at an early age.
If what appears to be eczema comes on after the age of three or four, there's a good chance it is not eczema, but some other type of skin irritation.
The skin of people with an eczema flare tends to show what is called "white dermatographism."
This means that if the skin is scratched with a pointed instrument, a red line will form, and then will turn white within about 10 seconds. After a flare, the person may have white spots on their skin. These are the harmless after-effects of the eczema inflammation. Some people with eczema will have pale skin around their eyes. They may also have an extra fold of skin beneath their lower eyelid. This fold is sometimes called Dennie's line, and may be due to extra water in the tissues of the face.
Prevention and Screening
Eczema cannot be prevented, but outbreaks can be controlled. [Table 2]
Table 2. Control Techniques for Eczema
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| Keep skin moisturized with non-medicated lotions, especially after bathing. |
| Avoid ointments that are too heavy, like petroleum jelly, which can worsen the condition by blocking pores. |
| Take short showers and baths; pat yourself dry, and avoid rubbing with a towel. |
| Avoid extreme temperatures. |
| Wear cotton clothing—avoid wools and synthetics that are irritating. |
| Avoid perfume, which can be found in detergents, cosmetics, lotions, sprays, and deodorants. |
| Try to reduce stress. |
| Get regular exercise. If sweat aggravates your eczema, avoid exercise during flares. |
| Consider special air filter and hypoallergenic bedding if allergic to dust mites. |
| Use a humidifier to keep air moist. |
Keep your skin moisturized.
Use room humidifiers and frequently apply nonmedicated lotions and moisturizers to keep skin moist. Avoid harsh soaps and chlorine-based cleaning products. Take short showers or baths. When washing your hands or face in the sink, do so quickly and only use soap when necessary. Do not rub yourself dry after showering, but instead gently pat the skin with a towel and follow immediately with moisturizer. Avoid skin ointments that are too heavy, such as vegetable shortening or petroleum jelly, which can block the sweat glands and worsen symptoms.
Avoid anything that triggers your allergies, such as extreme hot and cold temperatures, clothes made from irritating materials such as wool, and perfumes and detergents that contain dyes and perfume.
Avoid foods that have triggered eczema reactions in the past. Avoid extremely hot or cold temperatures. Avoid wearing clothes made from irritating materials, such as wool or synthetics. Try wearing only natural fibers, such as cotton. Do not wear perfume, perfumed lotions, or non-hypo-allergenic cosmetics. Avoid using clothes detergents or lotions that contain dyes or perfumes.
Take measures to control dust mites.
These can include special air filters and special bedding, and may prove helpful in cases where eczema seems to be focused on the head, neck, and hands.
Take steps to reduce stress in your life.
Sometimes stress can bring on an eczema flare. Exercise and pursue relaxing activities to reduce emotional stress. If sweat makes your eczema worse, try to avoid exercise during a flare-up.
