Atopic dermatitis (AD) is a type of eczema that causes intense itching for its sufferers. “It is a terrible ailment,” says Dr. Jeffrey Ross Gunter, a dermatologist at SummitMD Dermatology. “It afflicts all ages, including babies, and is lifelong. Fortunately, while there is no cure for it, I can provide relief for my patients, and they are able to lead normal lives.”
AD is characterized by an intensely itchy rash that disrupts people’s sleep and time at work and school. “You typically see excessively dry skin,” Dr. Gunter says, “and the rashes are very painful. The patient will first have itchy skin, and when they scratch it, the rash appears.”
How AD develops will depend on the person’s age. “In babies, you usually first see the rash on their cheeks, and it can feel raw, scaly, and dry. The rash, however, can also develop on the scalp and face,” explains Dr. Gunter. “The rash may bubble and weep fluid, which leads to itching that comes and goes. As you can imagine, this is very distressing for the baby, who has trouble sleeping and acts fussy.”
He says that between ages two and puberty, the rash usually appears in the creases of the knees or elbows. “You can, however, also spot it on the ankles, wrists, and neck and also in the creases of the buttocks and legs. The rash will evolve into scaly, itchy patches and might get bumpy. The child’s skin will sometimes turn leathery and thicken because of the frequent scratching. When the skin thickens, it will itch all of the time.”
With adults, the skin often has darker patches and becomes scaly. “A lot of adults with AD developed it as children,” says Dr. Gunter. “Adults have that same extremely dry skin but have additional symptoms, including cataracts, eczema on the eyelids, darker skin around the eyes, and hand eczema. The thickened patches of skin that children develop can become permanent when they reach adulthood.”
Some symptoms develop in all patients regardless of age. “I have treated patients whose skin was raw or even bleeding,” Dr. Gunter states. “This is because of the intense scratching that irritates the skin. You may see deep lines in the palms of the hands. Skin infections are also common, which you can spot because of the yellow crusts and pus-filled bumps.”
Dr. Gunter says that many patients experience depression and anxiety and also feel isolated. “AD interferes with their lives, and unless they get treatment, they feel helpless. They may avoid social engagements because they feel self-conscious about how their skin looks. This is why seeing a good dermatologist is crucial – they can work with the patient to create a treatment plan that will help the patient regain control of their life.”
He says that AD is a complex disease. “Why it happens could be determined by a variety of factors, including problems with a patient’s immune system, where they live, or what they are exposed to, including smoke, pollution, or stress. A family history of AD, hay fever, asthma, or food allergies can also contribute to AD.”
Dr. Gunter explains that there is hope for those who have AD. “The goals are to manage the disease, prevent flare ups, and avoid scratching. That last one is crucial because scratching leads to thickened skin, which itches all of the time. Understanding and avoiding triggers is one of the biggest tools a patient has. A person’s flare up is commonly caused by stress, wool, cold or hot weather, skin care products, or laundry detergents that have a fragrance.”
To find relief for AD symptoms, he also prescribes corticosteroid ointments and creams. “These medications help lock in moisture, preventing dry skin and further itching. If this is not enough to manage the disease, there are also light treatments that have been effective. These require the patient to come in several times a week for up to a few months.”
Dr. Gunter recommends that all people with AD be gentle with their skin. “Definitely use a moisturizer throughout the day, and when you shower, be sure to only use lukewarm water since hot water can exacerbate the itch. And be careful with skin care products. Those with fragrances can make the itch worse as well. Lastly, cotton clothing that fits loosely can bring comfort to people with AD.”
Ultimately, Dr. Gunter wants to know that there is relief for people struggling with atopic dermatitis. “Yes, it is unfortunately a chronic disease. However, there is so much that can be done to help you, so please see a dermatologist and work with them to set up a treatment plan that is right for you.”
Jeffrey Ross Gunter, MD, FAAD is a board-certified dermatologist at SummitMD Dermatology. He is a graduate of the Keck School of Medicine at the University of Southern California where he was previously a Clinical Professor of Dermatology and Chief Resident of Dermatology at the LAC/USC Medical Center in Los Angeles, CA.
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