Atopic dermatitis, the most common form of eczema, is a skin condition that begins shortly after birth. While it usually goes away as a child gets older, it can sometimes continue into adulthood.
This week on Take Care, Dr. Whitney High, associate professor of dermatology and pathology at the University of Colorado School of Medicine, discusses several skin conditions, their causes and ways to treat them. High is the director of the school’s dermatology lab and a fellow of the American Academy of Dermatology.
Atopic dermatitis usually first appears on the cheek of the face in the form of a red, scaly, weepy eruption. From there, it settles over time in an area such as the elbow, internal elbow or the back of the knee. The areas have a persistent weepy, oozy, red and very angry rash that’s itchy and bothersome.
According to High, no one is quite sure what drives the condition but some have theorized about such causes as poor barrier function.
“The barrier function is just the ability of the skin to keep water in and to keep annoying substances out,” High said. “So, some people think the barrier function breaks down in atopic dermatitis or childhood eczema and people become very, very sensitive to things that wouldn’t normally bother a person.”
People with atopic dermatitis are more sensitive than normal to fragrances, preservatives and other things in commonly-used products. The irritant is something one comes in contact with and not something they digest, as some believe to be the case.
High says food allergies driving atopic dermatitis is the exception, not the rule. The Academies of Dermatology and Pediatrics both are of the official opinion that food allergies are unusual causes. High stresses this so parents can be aware when treating their children.
“Some parents sometimes take it on themselves to go ahead and modify a diet,” High said, “and on rare occasion we’ve even seen protein deficiencies and things from parents who have decided their child is allergic to milk protein of their own volition and cause serious damage to their child.”
Questions doctors frequently will ask patients they suspect of having atopic dermatitis include: Can you sit on the grass with shorts? Do you cut the tags out of your shirts? Would you wear a wool sweater?
When treating the condition, High says doctors take two approaches to trying to calm the skin. The first is removing noxious insults to the skin and avoid objects that would bother it, such as clothing tags. The second is using medications such as topical steroids or antihistamines, including Benadryl, Atarax or Claritin, for their anti-itching properties.
Above all else, doctors communicate to patients the importance of moisturizing. They tell patients to use very bland, hypoallergenic, fragrance-free moisturizers, which can often be purchased over the counter. The concern is more that patients moisturize than what they use to moisturize.
“When I used to serve in an underserved area, we used to often recommend Crisco as a moisturizer, the canned vegetable shortening that you buy at the grocery store,” High said. “There’s a real potent effect of just well-moisturized skin retaining its barrier function and improving eczema.”
High also recommends such practices as diluted bleach baths. But, he stresses that patients must augment these options with medications subscribed by their physician.
Psoriasis
Psoriasis is an immune dysregulation disease which runs in a person’s family and has some kind of environmental trigger. It can cause a lot of scaling and silvery, scaled plaque on the elbows and knees as well as the back of the scalp and the gluteal cleft.
The disease can come with side effects that go beyond the physical ailment, according to High.
“It’s a very disfiguring disease for people affected,” High said. “They feel singled out like people feel they have an infectious disease or something like that. It can be very, very debilitating for the patient.”
Treatments vary based on the severity of one’s psoriasis:
- In minimal cases where the patient is not bothered by it, the doctor may not treat it at all
- In modest cases, the doctor may use topical medicines such as steroids or vitamin D-containing medication
- In more substantial cases, the doctor might use drugs that alter or suppress the patient’s immune system
Rosacea
Rosacea is a disease that most commonly manifests itself in the form of a person turning red, his or her face flushing easily and sometimes getting acne-like lesions on the face.
The condition is also called “The Curse of the Celts” due to the fact that it is most common in people of northern European heritage.
It can also emerge in a variety of ways, including a condition called rhinophyma where a person has a large, red-colored nose that is light-bulb shaped.
The first step of treatment is to try and identify a patient’s triggers. Triggers are different from patient to patient but can be alcohol, caffeine, wind exposure or sunlight exposure, according to High.
From there, treatment includes:
- Using topical metronidazole, an antibiotic, or a topical azelaic acid (due to their cooling effects)
- Oral medications, such as tetracycline antibiotics, may be used in more substantial cases
- For the redness, doctors may use some topical vasoconstrictors, which work like Visine does in one’s eyes
*A side effect of the vasoconstrictors is they can cause a rebound effect in some patients where they end up with more redness and vasodilation than beforehand
