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  Atopic eczema, irritant dermatitis and contact dermatitis


Atopic dermatitis (AD) is a non-contagious, common, chronic skin disorder of long duration. It is a condition of the eczema type of skin problems. Atopic is another word for an allergy like asthma and hay fever – and these conditions can also present in the affected individual. Dermatitis means skin inflammation. So together the words atopic dermatitis mean “allergic skin inflammation”. The main feature of atopic dermatitis is itchy skin usually causing the affected person to scratch – which further increases the itchiness. This leads to a vicious cycle of increased itchiness and vigorous scratching, complicating the condition.

Atopic dermatitis can affect people of all ages though it is not so common in adults. It is most common in children, affecting about 10% to 20% of them. Girls are more frequently affected than boys. In 90% of cases, the disease usually occurs before the age of five. For apparently no reason, it often worsens into conditions called flares, followed in adult life by complete remission. However, 60% of these children affected by atopic dermatitis continue to suffer from this disease in a more limited form in adulthood.

Atopic dermatitis needs special attention since significant social and financial costs are involved. The reported rising incidence of Atopic dermatitis is further increasing these costs. It is one of the main causes of workplace disability in adults and it is now the fourth most expensive disease in the U.S in terms of how much it costs the economy.


Causes of atopic dermatitis are not known, but hereditary and environmental factors are suspected. It seems certain agents trigger the onset of the disease. These include air-borne allergens, environmental factors, emotional stress, hormones, certain foods, and chemical irritants.

Children can inherit a genetic susceptibility to atopic dermatitis from parents having this disease or diseases like hay fever and asthma. A malfunctioning immune system can also be a cause that can be further exacerbated by a dry skin. Emotional factors were once believed, wrongly, to be a cause of atopic dermatitis, but it is now known they only worsen the condition – emotional stress does not actually cause atopic dermatitis.

Stages of atopic dermatitis

There are three stages; the infant, childhood and adult stage. Scratching and a desire for it, is the main feature of all stages.

Infant stage includes infants up to 2 years age and typically appears when they are 6 to 12 weeks old. There are rashes in many places but the diaper area is unaffected.

Childhood stage ranges from 2 years to puberty. Due to constant scratching, the skin becomes hard and scaly. The disease in some children goes into remission for a long time, returning at puberty due to hormones or other reasons.

Adult stage begins at puberty and follows a pattern similar to earlier stages. Adults may also develop eczema of the hand and foot. Those in occupations involving frequent hand washing and exposure to chemicals are more affected.


Symptoms vary between people but the common ones are, dry, itchy skin and rashes on the face, hands, feet, inside the elbows and behind the knees. Itching is the most important symptom. Itching is a particular problem during sleep when there is no control over scratching.


Since symptoms are unique to every patient, the doctor has to thoroughly examine the patient and his/her family’s medical history. This is done partly to detect the possible triggers for the disease. To aid diagnosis, two sets of criteria, grouped as major and minor criteria, have been developed. These are;

Major Features

  • Intense itching
  • Rashes in places typical of the disease
  • Chronic symptoms
  • Personal or family history of atopic disorders (allergies)

Minor Features

  • Early onset
  • Dry skin with scales or bumps
  • High immunoglobulin E levels in the blood
  • Skin creases on the palms
  • Hand or foot involvement
  • Lip inflammation
  • Nipple eczema
  • Susceptibility to skin infection
  • Positive allergy skin tests
Atopic dermatitis may be initially diagnosed if there are at least three features from both categories.

Presently, there is no single test to diagnose atopic dermatitis. There is a skin prick test, where a needle that contains the suspected allergen is applied to the skin to see if there is a reaction. However, the test only rules out or identifies a response to the tested allergens and does not positively identify atopic dermatitis.


Treatment has two main aims; healing the skin and preventing flares. For successful treatment, full cooperation in following the doctor’s instructions is essential.

Systemic corticosteroids are used only in resistant cases and for short periods of time. Side effects can include high blood pressure, damaged skin, weakened bones and cataracts. Consequently, systemic corticosteroids are a treatment of last resort. Most commonly topical corticosteroid creams are used.

For many years, topical corticosteroids have been prescribed to control inflammation. These drugs, however, can have side effects like, growth suppression, thinning of skin and infections. Because of this doctors hesitate to prescribe them to young children, but they are readily prescribed for adults and milder corticosteroid creams are available for teenagers.

For children above two years, new immunomodulators, which control inflammation, reduce immune system reactions and have few side effects, have been developed.

Tar preparations can also lessen inflammation and itching. Ultra violet (UV) light therapy is recommended in more severe cases.


An important part of the treatment regimen is preventive measures against exposure to substances, which worsen the atopic dermatitis condition. These are common irritants and allergens and include:

  • Wool or synthetic fibers
  • Soaps and detergents
  • Some perfumes and cosmetics
  • Animal dander and pollens
  • Dust and sand
  • Cigarette smoke

Avoiding these common irritants can help reduce the atopic dermatitis in many affected individuals. If other specific allergens are identified with a skin prick test then these too should be avoided.