To diagnose you with atopic dermatitis, your doctor may:
- Ask you about your medical history, including:
- Your family history of allergies.
- Whether you also have diseases such as hay fever or asthma.
- Exposure to irritants, such as:
- Wool or synthetic fibers.
- Soaps and detergents.
- Some perfumes and cosmetics.
- Substances such as chlorine, mineral oil, or solvents.
- Dust or sand.
- Cigarette smoke.
- Sleep problems.
- Foods that seem to be related to skin flares.
- Previous treatments for skin-related symptoms.
- Use of steroids or other medications.
- Identify factors that may trigger flares of atopic dermatitis by pricking the skin with a needle that contains a small amount of a suspected allergen.
Your doctor may need to see you several times to make an accurate diagnosis and to rule out other diseases and conditions that might cause skin irritation.
The two main goals in treating atopic dermatitis are healing the skin and preventing flares. You should note any changes in the skin’s condition in response to treatment to identify which treatments seem to work best.
Treatments can include:
- Medications: A variety of medications are used to treat atopic dermatitis.
- Corticosteroid creams and ointments are commonly used to treat diseases affecting the skin. If creams and ointments are not effective, your doctor may prescribe a shorter-term corticosteroid that is taken by mouth.
- Antihistamines that cause drowsiness can reduce nighttime scratching and allow more restful sleep when taken at bedtime.
- Calcineurin inhibitors applied to the skin decrease inflammation and help prevent flares.
- Barrier repair moisturizers reduce water loss and work to rebuild the skin.
- Phototherapy: Use of ultraviolet A or B light waves can be an effective treatment for mild to moderate dermatitis.
- Skin care that helps heal the skin and keep it healthy.
- Protection from allergens.
Atopic dermatitis may be treated by:
- Family doctors or pediatricians, who can help diagnosis the disease or refer you to specialists.
- Dermatologists, who specialize in skin disorders.
- Allergists, who specialize in allergies.
Besides medications, there are a number of things you can do to help control your atopic dermatitis.
- Skin care: Sticking with a daily skin care routine is critical to preventing flares. Skin care should include:
- Lukewarm baths to cleanse and moisturize the skin without drying it excessively.
- Using mild bar soap or nonsoap cleanser.
- Air-drying the skin after bathing, or patting it dry gently (avoiding rubbing or brisk drying).
- A moisturizer to seal in the water that has been absorbed into the skin during bathing. Use cream and ointments and avoid lotions with high water or alcohol content.
- Protecting the skin from excessive moisture, irritants, and rough clothing.
- Reduce allergen exposure. Examples could include:
- Encasing mattresses and pillows in special dust-proof covers, frequently washing bedding in hot water, and removing carpeting to reduce exposure to dust mites.
- Changing the diet in cases of a food allergy.
- Stress management and relaxation techniques to decrease the likelihood of flares. Developing a network of support that includes family, friends, health professionals, and support groups or organizations can be beneficial.
- Prevent scratching or rubbing, which irritates the skin, increases inflammation, and actually increases itchiness. Keep your child’s fingernails short to help reduce scratching.
- Maintain a cool, stable temperature and consistent humidity levels. Avoid situations where overheating occurs.
Atopic Dermatitis and Vaccination Against Smallpox. If diagnosed with atopic dermatitis (or eczema), you should not receive the current smallpox vaccine. You are more likely to develop a serious complication to the vaccine, even if your condition is mild or not presently active. Talk to your doctor if you have been in close contact with someone who has recently received the vaccine.
In infants, atopic dermatitis typically begins around six to 12 weeks of age. It may first appear around the cheeks and chin as a patchy facial rash, which can progress to red, scaling, oozing skin that may become infected. Other areas, such as the inner and outer parts of the arms and legs, may also be affected once the infant begins crawling.
In childhood, the rash tends to occur behind the knees and inside the elbows; on the sides of the neck; around the mouth; and on the wrists, ankles, and hands. Often the rash begins with small, round bumps that become hard and scaly when scratched. The skin around the lips may be inflamed, and constant licking of the area may lead to small, painful cracks in the skin around the mouth.
In some children, the disease goes into remission for a long time, only to come back at the onset of puberty when hormones, stress, and the use of irritating skin care products or cosmetics may cause the disease to flare. Even if the disease improves or disappears, the skin often remains dry and easily irritated.
Although a number of people who developed atopic dermatitis as children also experience symptoms as adults, it is also possible for the disease to show up first in adulthood. The pattern in adults is similar to that seen in children; that is, the disease may be widespread or limited to only a few parts of the body.