Atopic dermatitis or eczema is a terribly itchy skin condition that often affects people who come from families with hay fever and asthma. It is characterized primarily by thickened itchy skin on the front of the elbows, back of the knees and on the cheeks, but the rash can occur anywhere on the skin. The most likely cause is an overactive immune system. When a germ gets into your body, you produce an antibody that kills that germ. As soon as the germ is gone, your body stops making antibodies. In atopic dermatitis, the body keeps on making antibodies that end up in the skin to cause terrible itching. Antibodies are produced in response to infections, to bacteria on the skin, to allergies such as to pollen from ragweed, trees or grasses, and to certain foods.
Studies show that eczema can be controlled with daily injections of 100 mcg human gamma interferon (1,9) or measures to control infections such as sterilizing lotions (2) or continuous antibiotics (3,7,8). or scabicides to kill the dust mites that cause asthma or a stuffy nose (6).
A bacteria called staph aureus is often a trigger for attacks (3,7,8), so a doctor should take a culture from the patient's nostrils and if staph aureus is present, the patient should take an antibiotic such as a cephalosporin or Augmentin, for a week and place antibiotic ointment in the nostrils every night for several weeks. An exciting new study from Japan shows that atopic dermatitis can be controlled by repeatedly applying a 10 percent povidone-iodine solution twice a day (2). Helicobacter, the germ that causes stomach ulcers, can also trigger eczema (4); so can any inhalant allergen (5), such as dust mites (6).
The most effective treatment for atopic dermatitis is oral or injectable cortisone-type drugs such as prednisone. Doctors do not like to prescribe cortisones because they can cause serious side effects such as osteoporosis, obesity and stomach ulcers. Cortisone creams help to relieve itching a little bit, but with continued use, they can cause severe thinning of the skin. Antihistamines are of little benefit. Allergy injections often make the skin condition worse. Elimination diets to find and eliminate an offending food can help to get rid of problem foods that trigger attacks of itching, but they never clear the rash. Since staph aureus often is the cause of recalcitrant cases, I often prescribe azithromycin 500 mg twice a week for several weeks.
A study from England shows that strong cortisone-type creams used for a few days are as effective as weak cortisone-type creams used for weeks and months (12). Another study shows that tacrolimus creams are as effective as strong cortisone creams and do not cause thinning of the skin (13). Doctors have successfully treated both psoriasis and atopic dermatitis with a .03 percent ointment made by adding a single 1 mg pill of tacrolimus to one ounce of Vaseline, applied daily. The ointment is even more effective when covered with saran wrap (14).
A study in the Journal of Allergy & Clinical Immunology showed that feeding probiotics to pregnant and nursing mothers helps prevent atopic dermatitis (15). Finnish researchers showed that the children who develop atopic dermatitis have very high blood levels of allergic IGE antibodies and those breast-fed children whose mothers are fed good bacteria such as lactobacillus have a marked reduction in their blood levels of allergic antibodies. These children also have only one third the incidence of atopic dermatitis compared to those whose mothers were given placebos. If these studies can be repeated, all allergic mothers will be advised to take probiotics (good bacteria) during pregnancy and breast-feeding.
1) Archives of Dermatology July, 1998.
2) K Sugimoto, H Kuroki, M Kanazawa, T Kurosaki, H Abe, Y Takahashi, N Ishiwada, Y Nezu, A Hoshioka, T Toba. New successful treatment with disinfectant for atopic dermatitis. Dermatology 195: Suppl. 2 (1997):62-68.
3) P Strange, L Skov, S Lisby, PL Nielsen, O Baadsgaard. Staphylococcal enterotoxin B applied on intact normal and intact atopic skin induces dermatitis. Archives of Dermatology 132: 1 (JAN 1996):27-33.
4) K Murakami, T Fujioka, A Nishizono, J Nagai, M Tokieda, R Kodama, T Kubota, M Nasu. Atopic dermatitis successfully treated by eradication of Helicobacter pylori. Journal of Gastroenterology 31: Suppl. 9 (NOV1996):77-82.
5) L Brinkman, MM Aslander, JAM Raaijmakers, JWJ Lammers, L Koenderman, CAFM Bruijnzeelkoomen. Bronchial and cutaneous responses in atopic dermatitis patients after allergen inhalation challenge. Clinical and Experimental Allergy 27: 9 (SEP 1997):1043-1051.We conclude that allergen inhalation challenge causes a flare up of the skin lesions in atopic dermatitis patients.
6) MM Cameron. Can house dust mite-triggered atopic dermatitis be alleviated using acaricides? British Journal of Dermatology 137: 1 (JUL 1997):1-8. Permethrin is a very efficient killer of mites. It is used topically to treat scabies and head lice and is impregnated in bed nets to prevent mosquito bites. Even when applied to the skin in high concentrations, it has a very low toxicity in humans and other mammals. Permethrin-impregnated bedding may prove to be the best control method in the treatment of HDM allergen-triggered atopic conditions. House dust mite (HDM) allergens are the most important triggers for atopic dermatitis.
7) H Akiyama, J Tada, Y Toi, H Kanzaki, J Arata.Changes in Staphylococcus aureus density and lesion severity after topical application of povidone-iodine in cases of atopic dermatitis. Journal of Dermatological Science 16: 1 (NOV 1997):23-30.
8) F Giordanolabadie. Infectious complications of atopic dermatitis. Revue Francaise D Allergologie et D Immunologie Clinique 38: 4 (1998):345-348. Staphylococcus aureus superinfections are the most frequent.
9) SR Stevens, JM Hanifin, T Hamilton, SJ Tofte, KD Cooper. Long-term effectiveness and safety of recombinant human interferon gamma therapy for atopic dermatitis despite unchanged serum IgE levels. Archives of Dermatology 134: 7 (JUL 1998):799-804. Patients self-administered recombinant human interferon gamma, 50 mu g/m(2), by daily subcutaneous injection.
10) D Abeck, M Mempel. Staphylococcus aureus colonization in atopic dermatitis and its therapeutic implications. British Journal of Dermatology 139: Suppl. 53(DEC 1998):13-16.
11) D Abeck, M Mempel. Cutaneous Staphylococcus aureus colonisation of atopic eczema-mechanisms, pathophysiological importance and therapeutical consequences. Hautarzt 49: 12 (DEC 1998):902-906.
12) Randomized controlled trial of short bursts of a potent topical corticosteroid versus prolonged use of a mild preparation for children with mild or moderate atopic eczema. British Medical Journal. BMJ 2002;324:768.
13) J of Allergy and clinical Immunology April, 2002.
14) T Ruzicka, T Assmann, B Homey. Tacrolimus - The drug for the turn of the millennium? Archives of Dermatology, 1999, Vol 135, Iss 5, pp 574-580..
15) Journal of Allergy & Clinical Immunology 2002(Feb) Vol 109 No 1 pp 119-121.
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