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Atopic Dermatitis Causes Symptoms and Treatment

Atopic Dermatitis in Adults: Causes, Symptoms and Treatment

Atopic dermatitis can be an uncomfortable condition to live with and can be affected by everything rom your diet to everyday items you use as part of your lifestyle. 

Are Atopic Dermatitis and Eczema the Same Thing?

Atopic dermatitis is a type of skin rash called eczema that can affect both adults and children and might even affaect your pet It's what people often think of when they hear the word "eczema", however,  it's only one type of seven different eczema’s. 

What are some of the signs that you might be predisposed to atopic dermatitis?

keratosis pilaris picture image

As a dermatologist, some of the subtle signs I look for during a skin exam are:

  • small rough bumps on the backs of the arms and on the thighs (a condition called keratosis pilaris
  • dark circles under the eyes (Dennie-Morgan folds), and/or
  • extra lines on the palms (hyperlinear palms)

    It is a relatively common skin problem

    In the U.S., a little over 7% of adults have atopic dermatitis. Most people that develop this type of eczema manifest it when they are young and will gradually outgrow the problem. Globally, 15-20% of children suffer from the condition. Despite atopic skin problems typically presenting in childhood, I have seen them manifest for the first time in adults. This may be because the subtle signs of predisposition were missed earlier during childhood.  

    This is a skin problem that is typically inherited along with other atopic health conditions. Your family history of atopic conditions is one of the best ways to figure out if you are susceptible to atopic dermatitis.

    Some of the signs that you might have the genetic predisposition for atopic eczema in the family include having family members with:

    1. 'eczema',
    2. hay fever allergies,
    3. asthma,
    4. keratosis pilaris,
    5. hand dermatitis (also called hand eczema, dyshidrotic eczema or pompholyx),
    6. ichthyosis vulgaris picturedry skin,sensitive skin,
    7. excessively dry skin called ichthyosis vulgaris (which translates into 'common fish skin'!)

      What is the “Atopic Triad?

      People with asthma, dermatitis and allergic hay fever have what we call the "atopic triad". Having the atopic triad puts a person at risk for more severe involvement.

      I am a dermatologist and an atopic in a family of atopics!

      Yep, between my husband and I, we have every one of the conditions I just listed in our families - yes, we are atopics and the information that I'm sharing here is both personal and professional.    

      complete facial skin care for sensitive skin

      I know how important it is to learn how to care for atopic skin; the right skin care will help to keep atopic skin healthy, soft, strong and better able to resist eczema flare ups. My family's go-to routine includes:

      The Complete Facial Skin Care Kit (for facial skin care)

      Naturally Best Bar Soap (stocked in every bathroom shower) and Natural Face, Hand and Body Lotion (applied to all body skin after every shower)

      Naturally Best Bar Soap Fragrance free

      Survival Kit for Busy Hands (stocked at every kitchen sink to protect busy hand skin)

      Dermatologist approved hand skin care for eczema

      What are the skin lesions of atopic dermatitis?

      skin lesions of atopic dermatitis

      People suffering from an atopic dermatitis have chronic skin problems that include

      • itchy areas with scale,
      • redness
      • small weeping blisters that are overlaid with crust and scratch marks.

      The rash usually involves the creases of the elbows and knees but all skin can be involved. As the rash persists, skin becomes thick, scabbed, moist and infected. As lesions heal, they can leave discoloration and scarring.

      What causes atopic dermatitis?

      Atopic dermatitis is an inherited skin problem and it is not contagious. People who inherited atopic disease can begin suffering from it at any age though most will show signs in childhood. We know that people with atopic dermatitis have a genetic abnormality with their skin's barrier and a hyperimmune sensitivity to many environmental triggers. We haven't put the entire story together but there is a lot of active ongoing research to better understand this complex condition.

      Atopic dermatitis triggers in susceptible people may include:

      • Exposure to cold, dry climates.
      • Exposure to harsh skin care products including those with fragrance and even seemingly benign non-hypoallergenic botanical allergens like citrus.
      • Exposure to airborne pollution.
      • Exposure to classic environmental allergens such as pollen, animal dander, mold, grasses, mold etc.
      • Ingestion of certain foods including dairy, nuts and shellfish. However, it’s important to know that experts think that atopic eczema is exacerbated by, but not caused by, these foods.

      Dermatologist's skin care tips for atopic dermatitis

      dermatologist's skin care tips

      If your skin is prone to atopic dermatitis, it is really important to use a gentle and hydrating skin care routine 365 days a year. Yep, the fragile skin barrier and inherent skin intolerance of atopic skin means that you need to keep your skin care routine hypoallergenic, simple and consistent. This will keep your skin soft, comfortable and better able to fend off bouts of eczema.

      Simple 2 Step Skin Care Routine for Atopic Dermatitis:

      Step 1: Use only hypoallergenic fragrance-free pH balanced or entirely natural skin cleansers and warm water to cleanse your skin. 

      • Wash skin in warm, not steamy hot water to prevent removal of natural skin lipids and to reduce the chance of fueling skin itch and inflammation. 
      • Rinse off all soap or cleanser entirely to prevent skin irritation.

      Step 2: Apply a rich hypoallergenic moisturizing cream or lotion after toweling skin dry. This needs to be done at least twice a day.

      What are the best cleansers and soaps for atopic dermatitis?

      Vanicream cleansing bar pH balanced

      Dermatologist-approved fragrance-free pH balanced SYNDETS (synthetic detergents) are the mainstay of skin cleansing for atopic dermatitis. VaniCream Cleansing Bar is the ideal example. My personal favorite pH balanced SYNDET that I use daily for facial cleansing is Extremely Gentle Foaming Facial Cleanser which is enriched with subtle hypoallergenic lavender hydrosol.

      pH balanced facial cleanser for sensitive skin

      Naturally Best Bar Soap Fragrance free

      Those wanting to use natural products should focus on finding a naturally made soap without any botanical essences that may act as allergens or irritants such as Naturally Best Bar Soap. Natural soaps always have a slightly alkaline pH and may sting a rash of active eczema. This is what I stock in my home full of atopics with keratosis pilaris and ichthyosis vulgaris!  

      What are the best moisturizing lotions and creams for atopic dermatitis?

      Classically, dermatologist treated atopic eczema using moisturizers and emollients that were mineral oil or petrolatum based. They functioned as occlusives to trap water inside the skin. We often blended these petrochemical emollients with humectants such as glycerin.

      The petroleum-based emollients are the safest choice for a severe flare of atopic eczema, but today, many people want to use products made with therapeutic botanical oils including jojoba oil, shea butter, avocado oil, coconut oil etc. for daily care. The trick is to use only hypoallergenic botanical products without added botanical allergens such as citrus, sandalwood and other essential oils that can taunt allergy. 

      Dermatologist Approved Natural Body Lotion for eczema

      The ideal natural hypoallergenic botanical moisturizer for atopic skin care is my Natural Face, Hand and Body Lotion  which is fragrance-free and formulated for eczema-prone skin, rubs in and absorbs nicely and never leaves a greasy feel. 

      Facial moisturizers with ceramides, squalane and antioxidants can benefit eczema-prone facial skin and my top choice is Daily Moisturizing Face Cream. 

      Best Face Cream for dry face skin
      Dry Skin Hand Repair Cream

      Dry Skin Hand Repair Cream is a hand care moisturizer with a protective ingredient (dimethicone) formulated in a hydrating but non-greasy base. This special fragrance-free hand cream includes glycerin, hyaluronic acid and green tea to help protect and heal fragile atopic hand skin. Keep a tube by your most commonly used sink to apply numerous times a day after washing your hands. This is a key to preventing irritant hand dermatitis. 

      How often should you bathe when you have Atopic Eczema?

      how often should you bathe when you have eczema

      For years, atopic patients have been told by doctors to limit their bathing. The conflicting recommendations and practices have created confusion for the atopic community. Thankfully, new research finally gives everyone a clear answer and it's that bathing can help heal eczema!

      Why is there confusion about whether bathing hurts or helps eczema?

      It’s because bathing incorrectly will inflame and dry-out skin. The harmful effects of incorrect bathing include:  

      1. Harsh soaps irritate skin and dry it out by stripping precious skin lipids such as ceramides.
      2. Hot water turns skin red and makes it itch by dilating skin capillaries to increase the blood flow that delivers the mediators of inflammation. Hot water showers and baths also increase the stripping of skin lipids by harsh soaps. 
      3. Many people use allergen-filled skin care cleansers that create allergic contact dermatitis - another form of eczema - and atopics are highly prone to this problem. The most common allergens in skin care products include fragrance and some preservatives. People prone to atopic dermatitis must use hypoallergenic skin care products for all of their personal care needs!

      Bathing correctly is proven to help heal atopic dermatitis because: 

      1. Cool water reduces skin blood flow to help relieve itch; less blood going to the skin means fewer of the building blocks for itch and inflammation are present in the skin.
      2. Cool water soothes skin, relives itch and is less likely to sting than hot water.
      3. Water hydrates dry skin and can be ‘locked and loaded’ into the skin during bathing IF prompt application of water-trapping hypoallergenic moisturizers are liberally applied within the “magic 3 minutes” after patting skin dry with a soft towel.
      4. The limited/prudent use of pH balanced gentle SYNDET cleansers and hypoallergenic natural soaps help to remove pollen, pollution and skin bacteria that can worsen eczema.

        The bottom line with atopic dermatitis skin care:

        Good skin care makes a huge difference to controlling the rash of atopic dermatitis. Washing the skin daily can be good for it when done correctly and followed by regular application of a healing moisturizer. All skin care products should be hypoallergenic. A consistent gentle hydrating skin care routine will help maintain a healthy skin barrier, prevent skin allergies and keep skin healthy and comfortable.

        References:

        Løset M, Brown S, J, Saunes M, Hveem K: Genetics of Atopic Dermatitis: From DNA Sequence to Clinical Relevance. Dermatology 2019;235:355-364. doi: 10.1159/000500402

        Teet Pullerits, Erik P.Rönmark et. al., The triad of current asthma, rhinitis and eczema is uncommon among adults: Prevalence, sensitization profiles, and risk factors, Respiratory Medicine Volume 176, January 2021, 106250, https://doi.org/10.1016/j.rmed.2020.106250

        Prof Sinéad M Langan, PhD, Atopic dermatitis, The Lancet, SEMINAR| VOLUME 396, ISSUE 10247, P345-360, AUGUST 01, 2020, DOI:https://doi.org/10.1016/S0140-6736(20)31286-1

        Kapur, S., Watson, W. & Carr, S. Atopic dermatitis. Allergy Asthma Clin Immunol 14, 52 (2018). https://doi.org/10.1186/s13223-018-0281-6

        Pieter-Jan Coenraads, Hand Eczema Is Common and Multifactorial, Journal of Investigative Dermatology, Volume 127, Issue 7, 2007, Pages 1568-1570, ISSN 0022-202X, https://doi.org/10.1038/sj.jid.5700781.(https://www.sciencedirect.com/science/article/pii/S0022202X15334655)

        McLean WH. Filaggrin failure - from ichthyosis vulgaris to atopic eczema and beyond. Br J Dermatol. 2016 Oct;175 Suppl 2(Suppl Suppl 2):4-7. doi: 10.1111/bjd.14997. PMID: 27667308; PMCID: PMC5053269.

        Hon KL, Kung JSC, Ng WGG, Leung TF. Emollient treatment of atopic dermatitis: latest evidence and clinical considerations. Drugs Context. 2018 Apr 17;7:212530. doi: 10.7573/dic.212530. PMID: 29692852; PMCID: PMC5908267.

        Evangelista MT, Abad-Casintahan F, Lopez-Villafuerte L. The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. Int J Dermatol. 2014 Jan;53(1):100-8. doi: 10.1111/ijd.12339. Epub 2013 Dec 10. PMID: 24320105.

        Nina Poljšak and Nina Kočevar Glavac, Vegetable Butters and Oils as Therapeutically and Cosmetically Active Ingredients for Dermal Use: A Review of Clinical Studies, Front. Pharmacol., 25 April 2022, Sec.Ethnopharmacology, https://doi.org/10.3389/fphar.2022.868461

        Hadi HA, Tarmizi AI, Khalid KA, Gajdács M, Aslam A, Jamshed S. The Epidemiology and Global Burden of Atopic Dermatitis: A Narrative Review. Life (Basel). 2021 Sep 9;11(9):936. doi: 10.3390/life11090936. PMID: 34575085; PMCID: PMC8470589.

        Cardona ID, Stillman L, Jain N. Does bathing frequency matter in pediatric atopic dermatitis? Ann Allergy Asthma Immunol. 2016 Jul;117(1):9-13. doi: 10.1016/j.anai.2016.05.014. PMID: 27371966.

        Allan GM, Craig R, Korownyk CS. Atopic dermatitis and bathing. Can Fam Physician. 2021 Oct;67(10):758. doi: 10.46747/cfp.6710758. PMID: 34649901; PMCID: PMC8516174.