When my baby was two months old, he started to have tiny bumps and dry patches on his cheeks. As first-time parents, we didn’t know what to do. We applied baby lotion and thought it would help. Instead of healing, the dry patches became red and inflamed. Later, his soft baby skin became rough and leathery.
At our baby’s next wellness checkup, he was diagnosed with atopic dermatitis. We learned that atopic dermatitis is a type of eczema, a group of disorders that cause inflamed skin. It is a chronic condition; some people have it for a few years while others must manage it for life.
What causes atopic dermatitis?
In atopic dermatitis, the skin barrier becomes dysfunctional, leading to dry skin. Researchers do not know exactly why, but some studies suggest it may be because of a gene mutation that creates filaggrin. Filaggrin is a protein that helps the skin retain moisture and integrity. Without enough filaggrin, the skin barrier is weakened, causing it to become dry and prone to infections.
Hereditary and environmental factors may also play a role. When someone in your family has atopic dermatitis, hay fever, or asthma, it increases the chances of inheriting atopic dermatitis. Environmental factors like pollution, diet, stress, climate, or sensitivity to certain products may also trigger a flare-up.
What are the symptoms of atopic dermatitis?
Symptoms of atopic dermatitis may include:
Small, rough bumps
Itchiness
Dryness
Redness
Warmth
Blisters
Thickening
Change of skin color after healing
These symptoms may wax and wane and change over time. For infants up to 2 years, symptoms most commonly occur in the face, scalp, and skin areas around joint folds. In childhood to adulthood, atopic dermatitis usually affects other areas: elbows, knees, neck, ankles, hands, and feet.
How do you treat atopic dermatitis?
The treatment for atopic dermatitis focuses on maintaining the skin barrier, identifying triggers for flare-ups, and medications and other therapies when necessary. Keep in mind that everyone’s skin is different, so treatment plans may vary.
Maintenance of the skin barrier.
Keep the skin clean and moisturized. Bathe with lukewarm water and gentle cleansers, and moisturize at least twice a day. There are many moisturizers in the market; choose the one that works best. During flare-ups, consider using the Soak and Seal method.
Identify triggers for flare-ups.
Atopic dermatitis may cause the skin to become more sensitive and reactive. When using products, opt for ones that are hypoallergenic, fragrance-free, and formulated for sensitive skin. Choose clothing with breathable fabric, like cotton, bamboo, and silk. Other triggers may include certain foods, weather, and stress. A dermatologist or allergist may be able to help with identifying specific triggers.
Medications and Other Therapies
During flare-ups, medications and other therapies may be needed. The healthcare provider may prescribe different medications such as:
Topical corticosteroids: Steroid creams and ointments may be prescribed first to calm the flare-up and give the skin a chance to heal. Steroids have different strengths, and different parts of the body may need different dosages. Remember to always use topical steroids as directed to minimize adverse effects.
Other topical medications: Your provider may also prescribe other topical medications like calcineurin inhibitors, crisaborole ointment, or ruxolitinib cream depending on the severity of symptoms.
Systemic medications: Taken as injections or as tablets through the mouth, systemic medications work throughout the body. These are usually reserved for harder-to-treat cases of atopic dermatitis.
Immunosuppressant medications: Just like its name, immunosuppressants decrease the immune system’s response so it becomes less reactive to triggers.
Phototherapy: Also known as light therapy, phototherapy uses a special machine that emits ultraviolet light to reduce itching and inflammation.
Living with atopic dermatitis can put a toll on your emotional, social, and physical well-being. Remember that you are not alone. Although there is no cure for atopic dermatitis right now, there are resources. Consult with your healthcare provider and be part of local and online support groups. Take advantage of national organizations that can give you the information you need to manage atopic dermatitis effectively.
References
American Academy of Dermatology Association. Eczema types: Atopic dermatitis diagnosis and treatment. https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/treatment
American Academy of Dermatology Association. Atopic dermatitis clinical guideline. https://www.aad.org/member/clinical-quality/guidelines/atopic-dermatitis
Asthma and Allergy Foundation of America. Support groups. https://aafa.org/about-aafa/aafa-affiliated-asthma-allergy-support-groups/
Herbert, A. A., Rippke, F., Weber, T. M., & Nicol, N. H. (2020). Efficacy of nonprescription moisturizers for atopic dermatitis: An updated review of clinical evidence. American Journal of Clinical Dermatology, 21 (5), 641-655. https://doi.org/10.1007/s40257-020-00529-9
Moosbrugger-Martinz, V., Leprince, C., Mechin, M., Simon, M., Blunder, S., Gruber, R., &
Dubrac, S. (2022). Revisiting the roles of filaggrin in atopic dermatitis. International Journal of Molecular Sciences, 23 (10). https://doi.org/10.3390/ijms23105318
National Eczema Association. Moisturizer and lotion for eczema: Everything you need to know. https://nationaleczema.org/eczema/treatment/moisturizing/
National Eczema Association. About NEA. https://nationaleczema.org/about-nea/
National Eczema Association. Steps to soak and seal. https://nationaleczema.org/wp-content/uploads/2018/03/FactSheet_SoakSeal_FINAL.pdf
National Eczema Society. Clothing and eczema. https://eczema.org/information-and-advice/triggers-for-eczema/clothing-and-eczema/
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Atopic dermatitis. https://www.niams.nih.gov/health-topics/atopic-dermatitis
Stacey, S., & Mceleney, M. (2021). Topical corticosteroids: Choice and application. American Family Physician, 103 (6), 337-343. https://www.aafp.org/pubs/afp/issues/2021/0315/p337.html
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