Dr. M.J. Bazos, MD
Patient Handout
DERMATITIS,
ATOPIC
About Your
Diagnosis
Atopic dermatitis is a skin inflammation caused
by increased skin sensitivity to the environment. It often runs in families and
may occur with hay fever, asthma, or nasal allergies as well. Atopic dermatitis
is very common, affecting 1% of adult Americans, and 5% to 10% of American
children. It is not contagious and is not transmitted by any known organism. The
increased skin sensitivity causes an “itch” sensation, which in turn
causes the patient to scratch. Scratching, however, often provokes worsened
itching. Scratching can also break the skin barrier, increasing the risk of
infection. Atopic dermatitis is treatable, and with appropriate medications and
skin care, symptoms can be minimized or even eliminated. Without treatment,
however, the skin inflammation may worsen and become complicated by scarring or
infection.
Living With Your
Diagnosis
Signs and symptoms of atopic
dermatitis include reddened, inflamed, sensitive skin that feels dry and itchy.
A slight burning sensation may also be noted. With oral and topical therapy, the
dryness and itching can be
reduced.
Treatment
The
treatment of atopic dermatitis consists of moisturizing skin care and
anti-inflammatory medications. Although a simple, nonmedicated moisturizing
cream may be used on a daily basis, steroid creams are prescribed for severe
episodes of itching. Use these carefully and only as directed by your physician.
Do not use steroid creams on the face unless specifically directed to do so by
your physician. Oral medicines minimize the itch as well. One type,
antihistamines, provide relief from the itch by calming the nerve endings in the
skin. Unfortunately, most of these antihistamines also calm other nerves as well
and can be very sedating (sleep inducing). Check with your doctor about which
type of antihistamines you should use, and whether you should limit your
activity (avoid cooking, driving, etc.) while taking
them.
The second type of medicine taken
orally is a form of steroid. Often prescribed in “dose-pack” or
tapering regimens, steroids stop the inflammation, reduce redness, and minimize
the itch. Although they work well, side effects limit their use to severe
episodes. Long-term side effects from steroids (taken orally) include ulcers,
bone loss, weight gain, and hormone imbalances, so the medicines must be used
and tapered exactly as
prescribed.
The
DOs
• Do moisturize your skin on
a daily basis, even when symptoms are not present. You may use an oilbased cream
or ointment, and it is best applied immediately after bathing, while the skin is
still slightly damp. Lotions are generally drying and do not moisturize as well
as creams or ointments. Avoid products with fragrances (they may cause increased
sensitivity) and multiple components (if your skin worsens after using them, you
won’t know which component caused the worsening). Use hypoallergenic
products when possible. When itching becomes severe despite moisturizing, a very
mild over-the-counter steroid cream (1% hydrocortisone) may be used in addition
to your usual regimen. If no improvement occurs, it’s time to call your
doctor.
• Do use oral medicines as
recommended by your doctor for the full course of treatment. Do not stop
medicines sooner than recommended unless your doctor
approves.
• Do avoid any type of food
in which you may be allergic. Keeping a “food diary” may help you
identify foods that cause your skin to worsen. If food allergies are present,
avoidance of those foods may improve your skin disease somewhat. Ask your doctor
for help in obtaining testing for allergies if you have a history of asthma or
nasal allergies as well.
• Do
exercise on a daily basis. Be careful to avoid excessive dryness and irritation
that may result from the use of deodorant soaps afterward, and be sure to
protect your skin from sun drying and damage with an appropriate sunblock (SPF
15 or greater). After showering with warm, not hot, water and mild soap, be sure
to apply your usual lubricants.
• Do
monitor the dryness in your home. Heated homes in the winter can become dryer
than the desert! A home humidifier may help prevent excessive environmental skin
drying.
• Do keep fingernails very
short, to minimize the damage that may be done by
absent-minded
scratching. Wearing long pants and sleeves
will also minimize random
irritation.
• Do wash clothing and
linens in fragrance-free soap, and double rinse when possible, to minimize
irritating soap or detergent
residues.
The
DON’Ts
• Don’t allow
the skin to become excessively dry.
•
Don’t forget your daily skin regimen even if you are feeling well. Often
flares occur during vacations, moves, etc., when the usual routine is broken.
Plan ahead for trips by saving a supply of your usual skin care products and
keeping them readily available.
•
Don’t drive, cook, or operate machinery while using antihistamines that
cause drowsiness.
When to Call Your
Doctor
• If you have fever,
chills, nausea, or generalized
aches.
• If you have signs of
infection (worsening redness, pus).
•
If you are wheezing or having difficulty
breathing.
• If you have a severe
stomachache or bone pain when using oral steroids.