Atopic dermatitis, otherwise known as eczema, is a non-contagious chronic inflammatory skin condition. Eczema typically begins in infancy or early childhood and presents before the age of 5 in more than 90% of cases. Symptoms of eczema and flare-ups tend to stop in half of the children during adolescence. However, it can persist into adulthood for some individuals. And for others, it may begin in adulthood. It is very rare to develop eczema after the age of 60 and if this occurs, other diseases should be considered.
If you are dealing with chronic eczema conditions in North Texas, please contact one of our Denton Allergists
ECZEMA SYMPTOMS
The most common symptoms of eczema in Denton Texas include the following:
- Dry itchy skin
- Red/brownish patches on the skin
- Cracks and oozing of the skin
Eczema It is characterized by the “itch-scratch cycle.” It is characterized commonly to have this by a remitting relapsing pattern. The tendency is to scratch the skin when it is itchy. As this repeats, the skin barrier can become compromised, allowing irritants and allergens to cause further inflammation, perpetuating the disease. Over time, eczema may cause thickening of the skin. The distribution of the lesions changes with age. For children less than 2 years old, the eczema rash typically affects the face and the extensor surfaces of the elbows and knees (outer aspects). In older children, the flexure surfaces of the elbows and knees (inner aspect/creases) and the feet are affected. In adolescence and adulthood, the eczema condition become more variable and widespread with a predominance of the hands.
For many individuals, atopic dermatitis can negatively affect their quality of life. It is an important cause of school absenteeism and occupational disability. Sleep disruption is a major problem for patients and their families.
WHAT CAUSES ATOPIC DERMATITIS
It is unclear exactly what causes atopic dermatitis; however, it is thought to be a combination of genetic (inside out mechanisms) and environmental factors (outside in mechanisms).
Research has shown that some people with eczema have a mutation of a gene responsible for making a protein called filaggrin. This protein is important for maintaining a healthy protective skin barrier. Without this protein, the skin loses moisture causing dry, itchy, and infection-prone skin. We also know that children born into families that have a history of atopic dermatitis or other allergic diseases, such as asthma or allergic rhinitis, are more likely to develop atopic dermatitis, showing that atopic dermatitis may have a hereditary component. In addition, atopic dermatitis may be the beginning part of the “atopic march.” This term refers to the natural progression of allergic diseases that begins in early life, starting with atopic dermatitis, followed by food allergies, allergic rhinitis and then asthma. Studies show that up to 80 percent of children with atopic dermatitis develop asthma and/or allergic rhinitis later in childhood.
ECZEMA TRIGGERS
Environmental triggers definitely play a role; however, eczema affects everyone differently – what may trigger one person’s eczema may not be the same as another’s.
In general, the common eczema triggers include:
- Irritants / Chemicals, commonly found in soap, detergents, cleaners
- Physical and emotional stress
- Temperature and humidity changes, especially during the summer and winter months
- Allergens – pollen, dust mite, cockroach, pet dander and mold
FOOD ALLERGIES AND ECZEMA
Although most of the eczema is not related to food, research has shown that food allergies may trigger eczema symptoms in about 30% of children, under the age of 5, with moderate to severe eczema. The most common food allergies associated with atopic dermatitis include milk, egg, soy, wheat, peanuts, nuts and seafood.
ECZEMA DIAGNOSIS
Board-certified allergists in Denton (link to homepage) are specially trained to diagnose and treat atopic dermatitis. Diagnosis typically involves detailed history and thorough examination of the skin. Allergy skin prick testing may be helpful in identifying certain triggers, such as indoor or outdoor allergens. Food allergy testing is recommended for children with moderate to severe eczema and also if there has been a history of a reaction with a particular food. Laboratory testing is seldom needed but may help rule-out other conditions. If underlying contact sensitivity or contact dermatitis is suspected, patch testing can help identify certain chemicals exacerbating the underlying eczema.
TREATMENT OF ECZEMA
Atopic dermatitis is a chronic condition sometimes requiring multiple treatment strategies. Dry and itchy skin will lead to scratching which can lead to further skin inflammation and eczema flare-ups. Thus, the key to controlling the symptoms of eczema begins including
- Skin hydration
- Moisturization and routine skin care
- Bathe in warm water for about 5-10 minutes with gentle soap, such as Dove or Cetaphil
- Immediately afterwards, pat dry the skin and apply a moisturizer cream to the damp skin
- Emollients, such as petrolatum, can help seal in the moisture, especially after bathing. This can be done several times a day for dry skin.
You can discuss with your North Texas immunologists regarding the use of bleach baths to help reduce the overgrowth of Staphylococcus aureus . It has been discovered that most patients with atopic dermatitis have reduced diversity of their skin microbiome which contributes to the proinflammatory nature of their skin. Also elements of Staphylococcus aureus can act as an allergen.
ECZEMA AND OVER THE COUNTER OPTIONS
There are many over-the-counter products and some prescription emollients that can be helpful. Additional measures that can help prevent eczema flare-ups include keeping nails short and smooth, wearing cotton loose-fitting clothing, and using detergents that are fragrance and dye-free. Anti-histamines may be prescribed to help control skin itching. For active lesions, topical corticosteroid creams or ointments may be prescribed to help control the inflammation. Topical calcineurin inhibitors, such as Protopic and Elidel, and topical prostaglandin inhibitors, such as Eucrisa, are non-steroidal prescription medications that may help control the symptoms of eczema by blocking certain cells of the immune system. A newer topical treatment, Roflumilast, a selective highly potent PDE4 inhibitor with anti-inflammatory properties, was approved by the FDA in July 2024 for the treatment of mild to moderate atopic dermatitis in those 6 years of age and older. Studies showed itch improvement was noted as early as 24 hours and it was generally well tolerated. For skin infections or severe exacerbations, topical or oral antibiotics and steroids may be prescribed.
SEVERE CASES OF ECZEMA
Thankfully there are treatment options for more severe cases or cases requiring repeated topical/oral steroid courses. Allergen immunotherapy or allergy shots/drops are helpful in reducing atopic dermatitis symptoms as well as reducing topical steroids required to control symptoms. In 2017, the FDA approved a biologic medication called dupilumab (Dupixent) that treats moderate to severe eczema in patients 18 years of age and older (has also been used to treat severe asthma insert blog article from jan 2024- biologic therapy for asthma) . It works by blocking interleukin-4 and interleukin-13 which are proteins of the immune system linked to atopic dermatitis and flare-ups in certain individuals. Dupixent is an injection given under the skin (subcutaneous) twice per month.
There are other newly approved biologic therapies that work with different mechanisms as well. There are 2 options that block IL-13 (Tralokinumab and Lebrikizumab) both administered subcutaneously every 2 weeks approved for those 12 years old and older. Nemolizumab, a biologic therapy targeting IL-31 receptor (a mediator known to be significantly linked to itching), was approved in 2024 for those patients (ages 12 years old and older) who are not adequately controlled on topical steroids and/or calcineurin inhibitors. A different class of biologics, selective Janus kinase (JAK) inhibitors, have been approved in different preparations for atopic dermatitis. These medications have been shown to provide more rapid improvement in signs and symptoms however they should be evaluated on a case by case basis given their potential risk of serious adverse events (serious infections, cardiovascular events, cancer, thrombosis, death) and the need for laboratory monitoring. These risks were noted in a different type of JAK inhibitor which is not selective (versus these for atopic dermatitis that THare) thus it has broader immune suppression. These are available in both oral and topical preparations. The oral versions include Abrocitinib (100-200 mg orally daily) and Upadacitinib (15-30 mg orally daily) and are approved for patients older than 12 years old. The topical version is Ruxolitinib (a JAK 1/2 inhibitor), which is also approved for those 12 years old and older. With all of these biologic therapies, we do not recommend changing the daily skin care regimen and topical steroids/calcineurin inhibitors treatment until discussing with your allergist/immunologist. These medications may be prescribed for those whose eczema cannot be controlled well by other therapies.
WHEN TO CONSULT AN ALLERGIST?
Eczema can affect everyone differently. For some, eczema symptoms may be mild and manageable with simple measures. But for others, it can be more pronounced with frequent eczema flare-ups and could negatively affect their life. It can be a frustrating problem not only for the patient but also for family members. Our board-certified allergists at North Texas Allergy and Asthma center are specially trained to properly diagnose, identify triggers, and treat underlying atopic dermatitis in infants, children and adults. If you or your family member suffers from eczema, contact Denton allergist our office for an appointment so we can help manage your symptoms and make you feel better.
RELEVANT LINKS TO ECZEMA
https://my.clevelandclinic.org/health/diseases/9998-eczema
