Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis

Atopic dermatitis is a skin inflammation caused by increased skin sensitivity to the environment. It often runs in families and may occur with hay fever, asthma, or nasal allergies as well. Atopic dermatitis is very common, affecting 1% of adult Americans, and 5% to 10% of American children. It is not contagious and is not transmitted by any known organism. The increased skin sensitivity causes an “itch” sensation, which in turn causes the patient to scratch. Scratching, however, often provokes worsened itching. Scratching can also break the skin barrier, increasing the risk of infection. Atopic dermatitis is treatable, and with appropriate medications and skin care, symptoms can be minimized or even eliminated. Without treatment, however, the skin inflammation may worsen and become complicated by scarring or infection.

Living With Your Diagnosis
Signs and symptoms of atopic dermatitis include reddened, inflamed, sensitive skin that feels dry and itchy. A slight burning sensation may also be noted. With oral and topical therapy, the dryness and itching can be reduced.

The treatment of atopic dermatitis consists of moisturizing skin care and anti-inflammatory medications. Although a simple, nonmedicated moisturizing cream may be used on a daily basis, steroid creams are prescribed for severe episodes of itching. Use these carefully and only as directed by your physician. Do not use steroid creams on the face unless specifically directed to do so by your physician. Oral medicines minimize the itch as well. One type, antihistamines, provide relief from the itch by calming the nerve endings in the skin. Unfortunately, most of these antihistamines also calm other nerves as well and can be very sedating (sleep inducing). Check with your doctor about which type of antihistamines you should use, and whether you should limit your activity (avoid cooking, driving, etc.) while taking them.
The second type of medicine taken orally is a form of steroid. Often prescribed in “dose-pack” or tapering regimens, steroids stop the inflammation, reduce redness, and minimize the itch. Although they work well, side effects limit their use to severe episodes. Long-term side effects from steroids (taken orally) include ulcers, bone loss, weight gain, and hormone imbalances, so the medicines must be used and tapered exactly as prescribed.

The DOs
• Do moisturize your skin on a daily basis, even when symptoms are not present. You may use an oilbased cream or ointment, and it is best applied immediately after bathing, while the skin is still slightly damp. Lotions are generally drying and do not moisturize as well as creams or ointments. Avoid products with fragrances (they may cause increased sensitivity) and multiple components (if your skin worsens after using them, you won’t know which component caused the worsening). Use hypoallergenic products when possible. When itching becomes severe despite moisturizing, a very mild over-the-counter steroid cream (1% hydrocortisone) may be used in addition to your usual regimen. If no improvement occurs, it’s time to call your doctor.
• Do use oral medicines as recommended by your doctor for the full course of treatment. Do not stop medicines sooner than recommended unless your doctor approves.
• Do avoid any type of food in which you may be allergic. Keeping a “food diary” may help you identify foods that cause your skin to worsen. If food allergies are present, avoidance of those foods may improve your skin disease somewhat. Ask your doctor for help in obtaining testing for allergies if you have a history of asthma or nasal allergies as well.
• Do exercise on a daily basis. Be careful to avoid excessive dryness and irritation that may result from the use of deodorant soaps afterward, and be sure to protect your skin from sun drying and damage with an appropriate sunblock (SPF 15 or greater). After showering with warm, not hot, water and mild soap, be sure to apply your usual lubricants.
• Do monitor the dryness in your home. Heated homes in the winter can become dryer than the desert! A home humidifier may help prevent excessive environmental skin drying.
• Do keep fingernails very short, to minimize the damage that may be done by absent-minded scratching. Wearing long pants and sleeves will also minimize random irritation.
• Do wash clothing and linens in fragrance-free soap, and double rinse when possible, to minimize irritating soap or detergent residues.

The DON’Ts
• Don’t allow the skin to become excessively dry.
• Don’t forget your daily skin regimen even if you are feeling well. Often flares occur during vacations, moves, etc., when the usual routine is broken. Plan ahead for trips by saving a supply of your usual skin care products and keeping them readily available.
• Don’t drive, cook, or operate machinery while using antihistamines that cause drowsiness.

When to Call Your Doctor
• If you have fever, chills, nausea, or generalized aches.
• If you have signs of infection (worsening redness, pus).
• If you are wheezing or having difficulty breathing.
• If you have a severe stomachache or bone pain when using oral steroids.