What are the other Names for this Condition? (Also known as/Synonyms)

• Allergic Dermatitis
• Allergic Eczema
• Prurigo Diathésique

What is Atopic Eczema? (Definition/Background Information)

• Atopic Eczema, also known as Atopic Dermatitis (and a host of other different names), is an itchy skin disorder that is non-contagious and inflammatory
• The disorder is quite common and lasts for a long period of time. Chronically, it leads to the formation of scaly patches and red rashes on the skin
• Atopic Eczema is an inherited defect that is triggered by allergens or irritants, causing a super-sensitivity of the skin

Who gets Atopic Eczema? (Age and Sex Distribution)

• Atopic Eczema may start at an early infant stage (between the months 2-6) and can get carried well into adulthood
• Young children and adults may also develop this allergic condition, but the onset of the condition decreases with an increasing age. Individuals beyond the age of 30 years, rarely develop the condition
• Both male and female sexes are equally affected

What are the Risk Factors for Atopic Eczema? (Predisposing Factors)

Following are the risk factors for Atopic Eczema:

• Atopic Eczema is an inherited condition, and those with a family history of such illnesses, are highly prone to developing this condition
• It is estimated that young children below the age of one, have a 65% chance of developing the disorder. 90% of the children who develop the condition are below age five; thus, putting the childhood cohort at the highest risk
• Individuals living in harsh (low-humidity) weather conditions, urban areas, have an elevated risk
• Seasonal allergies (hay fever) and asthma are closely associated with the disorder in many individuals

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Atopic Eczema? (Etiology)

Though it is understood that there is a combination of genetic and external environmental factors at play in Atopic Eczema, the exact cause of this condition is unknown.

• The body immune system produces a hypersensitive reaction to the allergens and irritants that are in physical contact with the body
• A higher level of skin sensitivity is seen in individuals lacking certain proteins
• Atopic Eczema/Atopic Dermatitis is adversely affected, when the person is exposed to airborne allergens (like pollen, dust, smoke, perfumes, chemicals), food allergens (like milk and cheese, nuts, certain cereals, tomatoes), certain weather conditions (dry air, sudden temperature changes), or on physical contact with pets, and materials (such as wool, soaps, lotions)
• Food products with high histamine (chemical compound containing nitrogen that acts as a neurotransmitter) content, like milk products, seafood, alcohol, tomatoes, yeast, pizza, etc.
• Emotional stresses, swimming, or even taking a shower, are known to worsen the condition

What are the Signs and Symptoms of Atopic Eczema?

The signs and symptoms are linked to the age of the individual and the type of allergen/irritant that triggers the reaction. Intense itching with skin inflammation is a distinctive characteristic of Atopic Eczema, which is sometimes confused with another typical skin disorder, called psoriasis.

A few signs and symptoms include:

• Seasonal allergies and asthma are commonly observed in those with Atopic Eczema
• The skin reacts abnormally on contact with the allergens (which may be environmental, or food allergen)
• The entire body skin changes in appearance and may have blister like formations, dry crusty texture, change of color, etc.
• Skin bumps or folds may be observed on the thighs and arms
• The skin may break, causing oozing, or raw skin appearance from intense scratching
• Long-term scratching causes thick, leather like skin (lichenification)
• Bleeding from the ears, or ear discharge may be present
• If the outbreak is severe, then rashes may form anywhere on the body. The rashes commonly appear on the neck, hands, feet, elbows, and on the skin behind  the knees
• The red, flaky and scaly nature of the skin makes it open and vulnerable to other bacterial infections
• Children below the age of two are usually severely affected with the skin rashes appearing on their hands, feet, face, and even on the scalp

How is Atopic Eczema Diagnosed?

A study of the family history with a skin examination is done by the physician or skin specialist. A few diagnostic tests that are performed for Atopic Eczema/Dermatitis include:

• Skin biopsy
• Testing for allergies, especially when the individual shows other symptoms; or when rashes are present only on certain areas of the body (occurring on exposure to the trigger substance)
• Further tests may be required, if the condition is difficult to treat

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Atopic Eczema?

The complications of Atopic Eczema include:

• Fungal, bacterial, or viral infections on the skin surface
• Permanent scarring due to bouts of long-term intense itching

How is Atopic Eczema Treated?

Atopic Eczema has no cure. Nevertheless, the symptoms may be managed effectively on a short-term basis and the condition controlled by medications, if the trigger factors that cause the allergic reactions are determined.

The treatment methods involve:

• Taking proper skin care by avoiding the tendency to itch; using moisturizers or other topical creams to prevent skin from drying; taking antihistamine drugs (reduces itching)
• Avoidance of the trigger materials, allergens, certain food items that flare the condition
• Avoiding actions that activate a skin hypersensitivity reaction, like swimming, taking baths for a long time, scrubbing the body for a long time after a shower, etc.
• Topical medicines that are applied on the skin may include steroid creams, immunomodulators, coal tar based ointments, ceramide creams (to repair the skin), antibiotic creams, and others
• Topical corticosteroids must be chosen from the appropriate potency class and vehicle (ointment, cream, lotion) for optimal effectiveness and safety
• Topical immunomodulators tacrolimus, pimecrolimus, calcineurin inhibitors, and crisaborole are steroid-free
• Other treatment methods include wet-wraps, short term use of systemic corticosteroids, phototherapy (with ultraviolet light), use of immunosuppressant medications, etc. However, these may have certain side effects
• Injected interleukin 4 inhibitors are FDA approved for moderate to severe Atopic Dermatitis in children and adults
• Injected interleukin 13 inhibitor tralokinumab is approved for moderate to severe Atopic Dermatitis in adults
• The JAK inhibitor pills abrocitinib and upadacitinib are FDA approved for moderate to severe Atopic Dermatitis in adults

How can Atopic Eczema be Prevented?

Atopic Eczema is an incurable condition and hence, prevention involves the identification of the possible external trigger conditions that provoke the reactions.

• Bringing about certain dietary changes like avoiding foods that are known to contain high histamine content, avoiding processed food products, etc. have proven to be beneficial
• Proper dietary modifications excluding the food allergen products during pregnancy, and breastfeeding of infants following childbirth, have shown a significant reduction in the outbreak of incidence among children
• Any environmental factor or an identified irritant that causes an inflammatory reaction have to be avoided completely
• Modifications to lifestyle is another important focus - stress, strong emotions, shortage of sleep, etc. have to be avoided

What is the Prognosis of Atopic Eczema? (Outcomes/Resolutions)

• Atopic Eczema has no cure and makes for difficult treatment, if onset of the condition is at a very young age. Other negatively influencing factors include, the presence of other complications, like asthma and allergic rhinitis
• It is also very difficult to control the skin disorder, if there is a previous family history of eczema, and/or if a large area of the body is involved
• Atopic Eczema is a long-term condition with recurrence. But, with proper treatment and certain lifestyle modifications, it may be well controlled

Additional and Relevant Useful Information for Atopic Eczema:

If breast feeding is not possible, then using a partially hydrolyzed formula, containing cow’s milk protein, has also shown a reduction of Atopic Eczema condition, among young children.