Eczema: An Itchy Nuisance
By Darrel Arthurs, ARNP, DCNP
Eczema, or more specifically atopic dermatitis (AD), is one of the most common skin conditions affecting hundreds of thousands of individuals per year. It is most common in children, but can continue into adult hood becoming a life long nuisance.
The condition is genetic and associated with skin lipid and lipid production deficiencies, as well as filaggrin mutations. While there are entire studies conducted on the protein filaggrin and what it does within the skin it is most important to understand that without it the skin cannot hold onto water. Therefore, it is exceedingly difficult for people with eczema to maintain moisture within their skin. The mutation associated with decreased filaggrin production is present in approximately 50% of people with atopic dermatitis.
Atopic dermatitis usually begins in infancy, 3-6 months of age is most common, but it can develop, however, rare, later in life as well. Frequently, atopic dermatitis is associated with both asthma and allergies and the patient will have two or all three conditions. Itching is the most common symptom and will frequently keep the patient awake at night or even wake them from sleep in order to scratch. The itch is constant with no respite and quality of life is dramatically decreased with the patient constantly itching, scratching, bleeding, getting infections and losing sleep. Staph infections are common with this condition.
The winter months are normally worse for patients with this condition however, some patients report issues with the summer months as well. Sun exposure especially those of UVB are a treatment for atopic dermatitis, but it could be that some allergens become more prominent that time of year, affecting the patient, or even just that the skin becomes dryer with sun exposure creating a worsening condition for some patients.
The rash of atopic dermatitis often will begin as papules and then coalesce and spread into erythematous plaques with excoriations. For children the rash develops on the cheeks, often sparing the mouth, extensor surfaces and the scalp. Older children and young adults will have the condition in the flexural folds of the neck, elbows, knees and ankles. Adults who have the condition will have involvement of the hands, wrists, feet, ankles and face, especially around the eyes and across the forehead. More mature patients will frequently have lichenification of the affected areas especially those that have had the condition for many years.
Atopic dermatitis is a debilitating condition for many people and it is important to recognize and diagnose the condition appropriately. The American Academy of Dermatology spearheaded a research project and developed criteria for the diagnosis of AD in infants, children and adults. It can be found at: http://dx.doi.org/10.1016/j.jaad.2013.10.010. In my next article I will discuss some treatment options for all severities of the atopic dermatitis.
Arthurs' passion for dermatology developed while he was serving in active duty in the U.S. Navy. Since then he has accumulated over 11 years' experience in medical and surgical dermatology. Currently he works independently in a small city in northeastern Oklahoma. Arthurs is on the NADNP Board of Directors.