The Itch that Rashes!

By Dana Dalbak, PA-C

Atopic dermatitis, commonly called eczema, is ruefully known as the “itch that rashes”.  Patients with this skin condition suffer with itchy, inflamed skin.  The itching, which can be intense and miserable, often develops first.  Though scratching momentarily relieves the itch, it also causes the development of inflammation or rash.  The ensuing “itch-scratch-rash” cycle only worsens the dryness, itchiness, and appearance of the skin.

Healthy skin acts as a barrier to keep unwanted substances (such as allergens, irritants, and toxins) out of the body, and keep good things in the body (such as moisture).  When this barrier is not working properly, substances penetrate the skin and trigger an immune response.  Breakdown in the skin barrier also leads to moisture loss from the skin.  The end result is dry, itchy, inflamed areas of skin.  Recent studies point to a defect in a skin barrier protein called filaggrin as a factor in disease development in some patients.

Atopic dermatitis usually begins in childhood, often infancy, and is more common in individuals who have hay fever or asthma, or have family members who do.  The condition falls into a category of disease called “atopic”, which also includes food allergy, hay fever, and asthma.  These diseases may develop one after another over a period of years.  This is known as the “atopic march”.  Recognizing this progression can be helpful by leading to earlier diagnosis and treatment.  Atopic dermatitis is a condition commonly seen and treated by an allergist in their practice.

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Genetics play a role in the development of atopic diseases, although the exact way they pass from parent to child is not yet known.  This means that a person is more likely to have atopic dermatitis, allergies, or asthma if other family members have ever had these diseases.  If one parent has atopic disease, the likelihood is approximately 50% that a child will develop one or more atopic diseases.

Although eczema can affect any area of the skin, the location and appearance of rash often vary with age.  In early infancy, eczema is most prominent on the face and head with a red, weepy rash.  After six months of age, the outside of the elbows and knees may worsen, along with other areas than can be easily reached for scratching.

In older children and adults, the creases of elbows, knees, wrists, and ankles are more common, as well as around the eyes, and the rash will likely have a dry appearance.  A variety of presentations are possible, however, including scaling, bumps, thickening, redness, and cracking.  SOme individuals suffer with specific hand eczema. 

In more severe cases, atopic dermatitis can be body-wide and cause crusting.  Secondary skin infection may develop, requiring the use of antibiotics to half the cycle.  Although patients with atopic dermatitis often have higher levels of staph bacteria on the skin, the condition is not contagious.

Atopic dermatitis can improve with age.  However, the disease tends to be episodic, waxing and waning.  Specific triggers for exacerbations vary from person to person, but include dry winter air, stress, heat and sweat in the summer, exposure to food allergens, airborne allergens, or contact allergens, and cold viruses or other infections.

An important part of managing atopic dermatitis, and the relentless itch-rash cycle, is proactive skin care to keep the skin barrier intact.  Dry skin is brittle; moist skin is flexible.  Lubrication is of primary importance.  Moisturizers and barrier ointments work best when applied to damp skin, such as immediately after bathing.  Excessive scrubbing and toweling should be avoided.  Lotions containing alcohol must be avoided, as they are drying.

A combinations of prescription medications, over-the-counter medications, and topical therapies are used in the treatment of atopic dermatitis.  Specific allergens may be triggering exacerbations.  These allergens can be identified by an allergist.  An allergist can also identify skin care appropriate for your specific situation.  Although other medical specialities, such as dermatology, also see eczema patients, an allergist is able to test for possible allergen triggers.  A referral is not needed to see an allergist unless required by insurance.  With regular care, the itch that rashes can become the itch that vanishes!

Further information and resources can be found at your local allergist’s office, The American Academy of Allergy, Asthma, and Immunology (www.aaaai.org), or The National Eczema Association (www.nationaleczema.org).

Check out SWIA studies on eczema and atopic dermatitis; we may have the solution you have been waiting for.

Next article: Allergy Shots: Could They Help Your Allergies?

Midwest Allergy Sinus Asthma specializes in the treatment of immune-related disorders.  In addition to immunodeficiency, focus is given to the treatment of asthma, allergic rhinitis, hives, food, hypersensitivity, insect sting allergy, and anaphylaxis.  The center has also been a leader in clinical research for over 20 years.  If you suffer from allergies, asthma, COPD, or psoriasis you may qualify to participate in a clinical trial.  You may contact them at (309) 452-0995 or www.asthma2.com.  Their office is located at 2010 Jacobssen Dr. in Normal.