Itchy inflammation of the skin that appears in patches, usually in skin creases
- Usually first appears in infancy; sometimes persists into adulthood
- Often runs in families
- May be aggravated by extreme temperatures, certain foods, or stress
- Gender is not a significant factor
The intensely itchy rash that is typical of atopic eczema usually appears first in infancy and often disappears later in childhood (see Eczema in children). However, flare-ups of the rash can sometimes occur throughout adolescence and into adulthood. Atopic eczema often affects people with a family history of asthma or other allergic disorders, such as hay fever (see Allergic rhinitis). Flare-ups in adulthood are sometimes linked to factors such as stress, temperature change, or an allergic reaction to certain foods. Often, there is no obvious trigger.
What are the symptoms?
The rash usually appears in patches, typically on the hands, as well as in skin creases in areas such as the wrists, the backs of the knees, and the insides of the elbows. The face is also often affected, especially around the eyes and behind the ears. The symptoms may include:
Redness and swelling of the skin.
Small, fluid-filled blisters.
Dry, scaly, and cracked skin.
Thickening of the skin (known as lichenification) as a result of continual scratching.
Creases or folds below the lower eyelids (known as Morgan–Denny folds).
Bacterial infection sometimes develops in the affected area, resulting in further swelling and discomfort.
What might be done?
Your doctor will probably be able to diagnose atopic eczema from the symptoms. He or she may suggest a topical corticosteroid to reduce the inflammation. You should apply this sparingly and reduce the frequency of use when the rash begins to clear up. Avoid using topical corticosteroids on the face unless directed otherwise by your doctor. If topical corticosteroids cannot be used or have been used for a long period, your doctor may prescribe instead a topical preparation of a drug that modifies the functioning of the immune system (known as an immunomodulator), such as tacrolimus. Oral antihistamines may help to relieve the itching (see Antipruritic drugs). If the rash is infected, you will be prescribed oral antibiotics or topical antibiotics (see Preparations for skin infections and infestations).
You can relieve and help prevent symptoms by using emollients (see Emollients and barrier preparations) and special bath oil available over the counter. Self-help measures can be used between flare-ups (see Managing hand eczema).
What is the prognosis?
Atopic eczema can be controlled but not cured, and new patches of affected skin may appear at any time. However, the condition usually improves with age and is rare in elderly people.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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