Eczema on elbow
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Atopic dermatitis, commonly known as eczema, is a challenging skin condition to treat. In the United States, 11 percent of children have been diagnosed with this condition that can have a wide range of severity.

The cause has most recently been attributed to a mutation in a gene that codes for filaggrin, which is a protein that helps skin cells connect to the surrounding keratin barrier.1 Without a proper barrier, moisture is lost while allergens and environmental irritants have greater access to the inflammatory process of our immune system that causes the telltale stubborn rash to appear. 

Children who experience eczema are more likely to have food allergies, asthma and allergic rhinitis later in life. But while the vast majority of the respiratory and gastrointestinal tracts don’t have filaggrin, it has been postulated that immune cells are sensitized near the weakened barrier of eczematous skin and are distributed throughout the body by lymph and blood flow.

Usually, treatment consists of topical corticosteroids during flares in order to prevent dangerous secondary bacterial infections, but recognizing exacerbating factors and restoring skin function tends to take more time, especially with children.

To help reduce the incidence of future eczema outbreaks, ask your doctor about creating an eczema diary to help identify allergies and irritants such as food and soaps, daily use of low (or no) water content topical emollients, and ways to reduce itching.

Keep in mind that while stress, anxiety and certain foods are not likely the cause of atopic dermatitis, they may still contribute to symptoms in a frustratingly delayed context.2

Selecting topical emollients can be a very individual process. Although coconut oil and other similar oils may be preferred to a cream filled with preservatives, the greasy residue may be prohibiting to some. Either way, a “wet wrap’ of emollients in cotton dressing can be used in evenings.3

Finding a way to live with atopic dermatitis can be difficult. However, enlisting the help of a physician who can spend time identifying the cause and recommending the appropriately individualized treatment can be a big help. Best of luck!

 

[1]Irvine AD, Mclean WH, Leung DY. Filaggrin mutations associated with skin and allergic diseases. N Engl J Med. 2011;365(14):1315-27.

[2]Eigenmann PA, Calza AM. Diagnosis of IgE-mediated food allergy among Swiss children with atopic dermatitis. Pediatr Allergy Immunol. 2000;11(2):95-100.

[3]Akdis CA, Akdis M, Bieber T, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. Allergy. 2006;61(8):969-87.