Atopic dermatitis, or atopic eczema, is a skin disease that is common in young children. It turns out to be dry, red and itchy rash. Before the age of one, the rash usually starts on the cheeks and then comes elsewhere. From the age of two, they usually settle into arm folds or kneecaps. Therefore, eczema is also called flexural eczema.

The disease can also begin in older children and in adults who have not had eczema as a child, but it is more uncommon. Atopic dermatitis is not contagious.

Most children are only mild to moderate. Many people grow out of their flexor eczema, but some have eczema throughout their lives. Eczema can be better in periods, and then worse again.

Symptoms of atopic dermatitis

Common symptoms if you have atopic dermatitis are:

  • The skin is dry and can peel.
  • You get rashes that are red, dry, scaly, bumpy and that itch.

The red is better seen on light skin than on dark skin. The red may not be visible on dark skin at all.

It is often difficult to avoid itching. Therefore, the skin is easily damaged and can become infected with bacteria naturally found on the skin. If there is an infection, it may get fluid from eczema.

Atopic dermatitis sits in different parts of the body at different ages.

Symptoms of atopic dermatitis in children up to 2 years of age

In almost everyone, eczema begins during the first year of life. The rashes usually get on the cheeks and then often spread to other parts of the body. It can be, for example, the neck, chest, stomach and diaper area. Eczema can also be found on the outside of the arms and legs.

Itching is usually troublesome, especially at night. The very youngest children who are not itchy often get extra jerky and annoying. It is common for children to sleep poorly.

Symptoms in children between 2 and 12 years

From about two years of age, eczema usually settles more in bend folds and especially in the kneecaps, arm folds, wrists, and wrists. The child can also get hand eczema.

Symptoms of atopic dermatitis in teens and adults

In teens and adults, eczema may still be in the bend but usually has a different spread. There are mostly on the hands, neck, and face. On the face, it is common to have rashes on the eyelids, around the mouth, forehead, and scalp.

Other symptoms may occur

Anyone with atopic dermatitis may also have other symptoms of atopic dermatitis. Atopy is a collective name for several different disorders, such as asthma, pollen allergy, and eczema. Some have all the hassles, but some have only one or two of them. It is common for the atopic symptoms to change during different parts of life.

Often, children with atopic dermatitis also have asthmatic trachea, asthma, pollen allergy or any other hypersensitivity disease. Half of all children with atopic dermatitis will have pollen allergy or asthma later in life.

Different varieties of atopic dermatitis

There are several variants of atopic dermatitis that can look different:

  • In mild atopic dermatitis, lighter spots sometimes appear on the skin, usually on the face. These are called pityriasis alba. They don’t usually itch.
  • In atopic dermatitis, it is common to have small bumps on the outside of the upper arms. They are called keratosis pilaris and can sometimes itch. They are most common during their teens, then they become less visible.
  • Atopic winter feet mean that the skin beneath the soles of the feet and the big toe scales a lot and that the skin breaks. The trouble is most common during the winter.
  • So-called toilet seat eczema appears on and below the buttocks and is common in children with atopic dermatitis. This is not because the child is sensitive to the toilet seat itself.
  • Long-Lasting eczema that you have a lot of itchy can cause the skin to become thick and crumpled. It is called lichenification or elephant skin.

Things that make eczema worse

There are several things that can aggravate eczema:

  • Sweating due to hot clothes or physical activity.
  • Chemicals such as detergent and soap.
  • Dusty environments.
  • Water, especially chlorinated water.
  • Dry cold winter weather.
  • Reduced humidity indoors when the house is heated.
  • STRESS.
  • Diseases, such as colds or an eczema infection.

Eczema on the lips and around the mouth is often made worse by the fact that you often lick around your mouth when it feels dry.

In many children, itching is made worse by citrus fruits, tomatoes, strawberries, chocolate, and kiwi. It is not due to allergies, but because the skin is extra sensitive. It can be good to pay attention to whether something in the food seems to make the skin worse.

Food allergies can make eczema worse in young children

In children, food allergies, also known as food allergies, can make eczema worse. It is uncommon in adults. Especially under the age of one, there is usually an allergy to cow’s milk and sometimes to chicken eggs. If the child is allergic to cow’s milk, it usually passes before two to three years of age. Egg allergy usually disappears before school age. There may also be allergies to fish, soy, various cereals, and peanuts.

Infants with food allergies often have hives in eczema. Often, the child also has respiratory symptoms and stomach upset.

What can I do for myself?

Lubricate regularly

Lubricate the skin regularly with, for example, a cream that is softening if you or your child have dry and sensitive skin that easily itches. This reduces the risk of an eczema flare-up.

Although eczema has already flared up, it is important to lubricate with plasticizers.

Lubricating the skin relieves the itching and helps the skin maintain its natural protection against external influences. Examples of external effects may be that the skin is exposed to water, abrasion or chemicals such as detergent and soap.

Try non-prescription cortisone

Eczema is an inflammation of the skin that often requires treatment with cortisone, which suppresses inflammation and relieves itching. You can try to treat with prescription cream or ointment with cortisone for a week. Cortisone should not be used in children under two years without a doctor’s prescription.

Read more about cortisone and plasticizers in chapter Treatment.

Try not to itch

It is difficult to avoid itching, and it quickly becomes a habit. But itching causes more itching and makes eczema worse, so it’s important to try not to.

If a small child has an itch, you can try to get the child to focus on something else, such as some play.

Let the child sleep in full pajamas and socks. Cotton gloves can be good if the child is itching a lot. Make sure the nails are cut short.

Avoid what you know causes itching

By not exposing your skin to more stress than necessary, you can often keep eczema under control.

Here are some tips that usually reduce problems:

  • Avoid excessive washing with water and soap. Many who have dry skin cannot tolerate bathing or showering more than every other day. Use mild soap and avoid too much-perfumed products. At the pharmacy, you will find wash cream and shower oil for dry and sensitive skin. Hair spray and hair gel can make it itchy on the scalp. Taking cool baths can help with the itching.
  • Use unscented detergent and avoid rinse aid. Do not overdose on detergents. It is good to find out if the water is hard or soft where you live to know how to dose. You can inquire at your municipality or search the municipality’s website.
  • Sunbathe carefully and avoid burning yourself, as eczema skin is extra sensitive and easily becomes dry and thin.
  • Try to avoid dry and warm climates indoors, especially where you sleep. For example, you may have cooled down in the bedroom.
  • Avoid dressing too hot as sweating can cause itching. Woolen clothing can irritate and itch and synthetic clothing can make you sweat easier. Preferably wear cotton clothing closest to the body. There are also other materials that can work well, such as silk and bamboo.

Some professions are inappropriate if you have eczema

You who have or have had eczema as a child should not choose certain professions. Although eczema disappears as you get older, you have poorer skin protection and increased sensitivity to external stress. For example, it may be inappropriate to choose a profession where the skin is subject to irritation by, for example, water or chemicals.

When and where should I seek care?

Contact a health care center if any of the following is true:

  • Your child under two years has severe itching and daily treatment with plasticizers for two weeks has not helped.
  • You or your child over two years have severe itching and have not improved after a week of treatment of atopic dermatitis with prescription cortisone.
  • You or your child have eczema that gets worse, spreads or looks different, such as fluid or small blisters.

If the child is younger than six years, you can contact the childcare center, eg.

Treatment of atopic dermatitis

Treatment of eczema primarily consists of lubricating with plasticizers and cortisone. Other drugs and light therapy may also be included in the treatment.

It is good to know that it takes time to treat eczema.

Important to use plasticizers

In the case of atopic dermatitis, the normal protection of the skin is impaired and the skin lacks fat and moisture. Therefore, it is very important to add fat and moisture with the help of plasticizers, which are available as cream and emulsion. An emulsion is more fluid than cream, much like a regular skin lotion.

There are many different plasticizers. They may contain different amounts of fat and different substances that retain moisture in the skin.

Humectants found in several plasticizers are propylene glycol or urea. Propylene glycol also has a weak bactericidal effect. Softeners containing urea can burn if you have very dry and sore skin. They can, therefore, be difficult to use for young children.

You can buy plasticizers over the counter at pharmacies. They are non-prescription even in large packages, but if you get them on prescription, they are included in the high-cost protection.

Lubricate frequently and abundantly

It is important to regularly lubricate with plasticizers. This also applies in periods when the eczema is better, to prevent relapse.

You usually need to lubricate several times each day. Always lubricate after the skin has been in contact with water. You can use plasticizers on your entire body.

Use plenty of plasticizers. Take a firm click and massage into the skin with your entire hand.

Cortisone suppresses inflammation

Cortisone is an anti-inflammatory drug that reduces itching. It is available in various forms, for example, cream, ointment, and emulsion.

By regularly lubricating with cortisone, the problems of eczema are usually alleviated. You should only apply eczema itself.

It is unnecessary to lubricate with softener on eczema when you have just lubricated it with cortisone. But if you want to lubricate with both at the same time, you should lubricate with cortisone first. If you first lubricate with plasticizers and then with cortisone, the cortisone is largely ineffective. If eczema becomes dry between the cortisone treatments, it is good to also smear eczema with a plasticizer.

If your doctor has prescribed you to lubricate with cortisone once a day, it is good to lubricate with plasticizers in the morning and cortisone in the evening.

Cortisone is available in various strengths

The cortisone drugs are available in four different strengths. They are called mild (group I), medium (group II), strong (group III) and extra strong (group IV). The mild ones you can buy prescription at pharmacies. The stronger ones are prescription.

The drugs contain various active substances. It is the substance itself that determines if it is a mild, medium, strong or extra-strong cortisone. The percentage figure on the packaging says nothing about how strong the cortisone is. The percentage figure shows how much of the active substance is included. For example, a strong cream maybe 0.01 percent while a mild cream maybe 1 percent.

Use the correct strength on the cortisone

Which strength you should use depends on how severe the eczema is. It is common to start with stronger cortisone, which suppresses eczema within a few days. It is important to use as low cortisone as possible if you are taking long-term treatment. But it is also important that it is strong enough to help. It can sometimes be difficult to find the strength that works best and you can try it out.

It is important to be extra careful with strong cortisone when treating areas where the skin is thin and sensitive since side effects such as bruising become more evident there. Thin skin is found on the face, groin, breasts, and abdomen.

It is important that you know when to use stronger cortisone and how to go down. Talk to a doctor or nurse at the BVC or health center if you are unsure how to do it.

Lubricate with cortisone until eczema has healed

It is important to continue lubricating with cortisone until the eczema is healed and the itching has disappeared so that it does not flare up again. Then you can lower the treatment by lubricating less frequently or with weaker cortisone.

Important with the right lubrication technique

It is important that you lubricate properly. You can get information on the correct lubrication technique at the health center or child care center. In some places, for example, some health centers, skin clinics, and children’s clinics, there are lubrication schools. There, parents and children learn the proper lubrication technique.

Difficult to sleep due to itching

Children who have a lot of itching at night and have difficulty sleeping may for short periods benefit from drugs called antihistamines. Antihistamines have a good effect on pruritus in, for example, hives, but do not reduce itching in eczema. Instead, the sleep-inducing effect of certain antihistamines is utilized. Children who sleep well itch less so that eczema may be satisfied and can heal better. The child may be given sleep-depriving antihistamines by prescription. Even adults can be helped by sleep-depriving antihistamines.

It is good to know that some children may react the opposite and instead become anxious and agitated by antihistamines. Others may get tired the day after.

If eczema becomes infected

If eczema deteriorates rapidly and looks different, it may be because it has become infected. Often it can be noticed that eczema does not get better by the treatment that usually helps. Eczema can also become fluid and small yellow blisters may appear. Antibiotic treatment is usually needed.

Phototherapy

Sun in moderate amounts is good for most and makes eczema better. Therefore, so-called medical light therapy is sometimes used as a supplement. Then you get to sunbathe in a special medical solarium. Medical tanning beds are different from the tanning beds you can sunbathe in to get brown.

Immunosuppressive drugs are an alternative to cortisone

Immunosuppressive drugs are alternatives to cortisone. They are prescription and examples of such drugs are an ointment called Protopic and a cream called Elidel.

These drugs cause the immune system in the skin to change and become less active. The irritation will then be less.

Immunosuppressive drugs are used only when cortisone does not have a good effect or if cortisone is inappropriate for some reason. They should not be used for children under two years.

The cream or ointment should be applied in a thin layer and should not be used regularly for a long time.

Tablet immunosuppressive drugs

You who are an adult and have very severe eczema may need immunosuppressants in tablet form for eczema to improve. That treatment is always done by a skin specialist.

If eczema does not heal

If eczema does not improve even though you lubricate every day, it is often due to so-called under-treatment. It may be that you are lubricating too little or that the cortisone is too weak, or both. It may also be due to the eczema being infected.

You can contact a dermatologist who has eczema school. There, among other things, you will learn how to properly lubricate, which creams are appropriate and which factors worsen eczema.

You can get a bath with the substance potassium permanganate that has a bactericidal, anti-inflammatory and itchy effect.

If there is a child who has problems, sometimes the whole family can be hospitalized for a few days to calmly take care of the child and get help.

Investigation

When the diagnosis is to be made, the doctor assumes that the skin is itching and if you have at least three of the following symptoms:

  • You have ever had eczema in the bend.
  • You have had asthma or pollen allergy.
  • You have had dry skin for the past year.
  • You have visible eczema in typical areas, such as in flexural folds, or for children under four years on the cheeks and forehead and the outside of the legs and arms.
  • Your rash has started before the age of two.

In young children, eczema can sometimes be triggered by allergies to foods and fur animals. It can be investigated at a pediatric clinic.

Allergy Investigation

If you have mild or moderate atopic dermatitis and the usual treatment works well, usually no investigation is done to find out if you have any allergies.

The exception is children under five, where allergy can be a triggering cause of eczema. Then the child can get a referral to a child ward or skin ward to do an allergy investigation. It shows if there is an allergy to any food, fur or pollen. The child’s or parent’s own story is also an important part of the allergy investigation.

Tests on older children and adults can show allergy to food or other substances in the environment, but most often the eczema is not affected much by the allergy.

Bacterial culture shows whether the eczema is infected

If eczema has gotten worse and the doctor thinks it is a bacterium that has infected the skin, a bacterial culture can be done. The doctor then takes a test in eczema with a cotton swab. The sample is sent to a laboratory and you will receive a reply within a maximum of five days.

What does atopic dermatitis depend on?

Why some get atopic dermatitis is not entirely clear, but inheritance and environment play a role. You may inherit a tendency to get dry skin and eczema, just like pollen allergy and asthma. The environment can have an impact by, for example, having a job that gives you eczema, or living where the climate stresses the skin a lot. In many countries, the air is very dry during the winter, both outdoors and indoors. This may be one reason why eczema is more common here than in countries with warmer climates.

One reason for atopic dermatitis may be that the balance between different substances in the immune system is different. The immune system is supposed to take care of infections, but in the event of an imbalance, it targets the body’s own cells, such as the skin cells.

Sometimes an allergy is important to trigger eczema. But more than half of those with atopic dermatitis have no allergy or overproduction of antibodies that trigger an allergy.

Skin protection becomes worse

The skin consists of several layers. The outermost layer of skin is called the epidermis, where new skin cells are constantly being formed that eventually die. The upper part of the epidermis is the horn layer which consists of these dead skin cells. Normally, it takes about four weeks for the skin cells to regenerate and die, but for those with atopic dermatitis, it goes faster. Then a normal horn layer is not formed, which makes the protection of the skin worse.

The skin’s protection is also impaired by the fact that the top layer of the skin contains less of some fats. This makes the skin more difficult to bind to water and therefore easily becomes dry.

Ehtisham Nadeem

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