Atopic Dermatitis: In Depth

Background

Quite simply, atopic dermatitis  is the result of a faulty skin barrier. The skin barrier does not function as normal, and thus, the skin loses vital moisture and also becomes easily penetrated by allergens, toxins, and irritants. For a more complete understanding of the skin barrier, I suggest that you read the handout I wrote called “Skin Barrier Education,” and the booklet I wrote, “The ABC’s of Dry and Sensitive Skin.” A person cannot begin to understand atopic dermatitis unless he or she first understands the human skin barrier. Now, interestingly, Vaseline ointment can work as a temporary skin barrier for atopic prone people. Just apply Vaseline ointment two or three times a day and the patient will improve. Stop the Vaseline, and the patient will get worse. Strip the skin oils with Dial, Zest, Ivory soap, or bath gels, and the patient will get worse. So, in a very simple nutshell, Vaseline combined with very gentle cleansers, will help prevent atopic dermatitis  flares.

What Is It?

Atopic dermatitis is a chronic inflammatory disease of the skin that is often associated with other allergic disorders affecting the respiratory system,such as asthma or hay fever. Possible complications include: 1. Secondary bacterial infection in the affected area.2. Increased susceptibility to adverse drug reactions. 3. Decreased resistance to fungal and viral infections. 4. Permanent scarring from scratching. The final outcome is unpredictable. Flare-ups and remissions may occur throughout life. Signs and symptoms of atopic dermatitis include: 1. Itching rash in areas where heat and moisture are retained, such as skin creases of elbows, knees, neck, face, hands, feet, groin, genitals, and around the anus. 2. Dry, thickened skin in affected areas (lichenification) 3. Uncontrolled scratching (frequently unconscious) 4. Chronic fatigue from loss of sleep due to severe itching. The causes are unknown, but the disease is probably inherited and probably related to immune system abnormalities.

Risk increases with: 1. hay fever or asthma. 2. Food allergy. 3. Family history of atopic dermatitis or other allergic disorders. 4. Stress. The rash and itching increase during stressful periods. 5. Use of immunosuppressive drugs. Atopic dermatitis, also known as atopic or allergic eczema, this chronic, relapsing, itchy skin condition is usually inherited and is characterized by episodic acute flare-ups. In 70%, it is generally associated with a family history of one or more of a triad of allergic diseases: asthma, hay fever, or atopic dermatitis, and usually begins in infancy or childhood. Any of several factors may be involved in the etiology (underlying cause) of the disease in a particular patient. One of the most important of these factors is dryness of the skin, which appears to be due to a higher tendency towards water loss from the skin of people with atopic dermatitis. This dry condition tends to be exacerbated during periods of low humidity. For this reason, it is very important that you follow the guidelines explained in my educational booklet on dry and sensitive skin: The ABC’s of Dry and Sensitive Skin.

Proper moisturization can help prevent the often uncomfortable skin symptoms of atopic dermatitis. Sufferers of atopic dermatitis always have very dry, brittle skin. The external layer of the skin (called stratum corneum) acts as a barrier, protecting what lies underneath. When the stratum corneum cracks because of dryness, irritants can reach the sensitive layers below and cause a flare-up of atopic dermatitis. To prevent dry skin, the best and safest treatment is the use of moisturizers. Moisturizers provide a layer of oil on the surface of the skin, trapping water beneath and thus making the skin more flexible and less likely to crack. Normally, your skin moisture is protected by a thin film of oil lightly covering the surface of skin cells. Soap can wash this protective oil film away, and your skin can lose moisture. Dry air further causes the skin to lose moisture, and your dried skin can scale, flake, and crack. The tiny cracks in the skin are also called “fissures” and occur within the lines of the skin. As tiny dry fissures deepen within the skin lines, inflammation and sometimes infection develops, leading to a medical condition called: asteatotic or xerotic eczema, the medical names to describe severely dry skin. The words “eczema” or “dermatitis” are the same and refer to inflamed skin. In addition to dryness, Allergies to certain foods may also play a role in some patients; this factor, however, has probably been over-rated. Wool, as well as lanolin (wool fat), appears to be irritating to the skin of patients with atopic dermatitis. Finally, emotional stress and nervousness can aggravate almost any pre-existing skin condition, such as itching, and can be a principle factor in perpetuating the continuous "scratch-itch" cycle.” Other precipitating factors include extreme allergies to house dust mites, animal dander, plants, molds, fabrics, rugs, and other allergens. Sensitive atopic skin can become itchy when exposed to allergic type substances such as perfumes, dyes, conditioners, powders, anti-perspirants, hair sprays, grasses, plants, fragranced products, shampoos, unrinsed laundry detergents, fabric softener sheets, dog or cat hairs, carpets, chemicals, Aloe Vera, PABA, detergents, acrylic nails, polishes, nickel, elastic, latex, etc. Hair conditioners can induce itch!

 

How Does It Begin?

Approximately 65% of patients with atopic dermatitis develop the disease during the first year of life, and 90% will do so before age 5. There is, however, seldom any evidence of disease present at birth. On occasion, however, a follicular (hair follicle-like) eczema and/or erythema (redness) may be noted within the first few weeks of life, which begins on the exposed areas. By the time the infant is 2 to 3 months old, coordinated rubbing and scratching begin, and a more typical picture of eczema manifests itself, especially if the baby is not well moisturized. Atopic lesions in the infant are usually distributed on the face, scalp, and extensor surfaces of the extremities, or can be generalized throughout the body. The rash is often weeping and vesicular (blistery), with oozing, crusting, and excoriations.

How Does It Progress?

As atopic dermatitis progresses, extensive hair loss may occur in cases of severe scalp involvement. The scalp hair will return once the dermatitis remits, except in those rare areas where scarring has occurred. In older children and adults, the primary distribution of atopic lesions generally includes the neck, antecubital and popliteal fossae (flexor areas), wrists, and ankles. The dorsal surfaces of the hands and feet, as well as the ears, may also be affected; the rash may also be generalized, but this is unusual except in acute exacerbations (flares). Frequently, the infantile form of atopic dermatitis may become milder and perhaps remit completely by age 4 or 5. These patients, however, are often subject to flare-ups by puberty and the late teens, which can go on to become chronic eczema, and can be associated in about thirty percent of cases with allergic asthma or hay fever. The skin manifestations of chronic atopic dermatitis are characterized primarily by marked skin dryness (xerosis), thickening (lichenification), pruritus (itch) excoriation (scratch marks), and even scarring. The skin may develop a silvery sheen due to dryness, and may be subject to superinfection by bacterial agents, such as Staphylococcus aureus, by fungal organisms, or by viruses, the most common of which is herpes simplex. Superinfection is of particular concern during acute, weeping flare-ups. Dermatitis may also occur periorbitally (around the eyes), and can range from mild dryness and scaling to severe lichenification of the eyelids. The so-called "allergic shiners" seen in atopic persons are manifestations of this condition. Other eye findings in chronic dermatitis include a type of conjunctivitis which results in roughening of the inner lining of the eyelids and can lead to corneal abrasion ("vernal conjunctivitis"); keratoconus, a condition in which the cornea becomes cone-shaped and may require transplantation; and cataracts, either as a result of the atopic dermatitis itself, or as a side effect of systemic steroids or of topical steroids used around the eyes as part of treatment.

How Is It Treated?

If your child or you have atopic dermatitis, your daily moisturizing routine is far more important than any medication Dr. Jacobs can prescribe in the office. This is because your skin reacts to the environment at a level much higher than the average person. Your skin is not "bad" skin. In fact your skin is very special and requires special treatment. Your skin produces less oil and therefore loses its protective layer faster. Your skin will dry much faster than normal. The following are methods of dealing with this problem. The mainstay of therapy in atopic dermatitis and chronic eczema, as well as in acute flare-ups is the maintenance of good skin hydration. This can be best accomplished in chronic dermatitis by bathing no more frequently than once per day (in order to preserve the natural oils of the skin) and through the use of special moisturizing “non”-soaps with minimal defatting activity. Cream moisturizers  should be used liberally, at least three or four times daily, particularly after bathing.  Exactly how are you supposed to moisturize? The most important part of moisturization therapy is to first restore moisture to the skin. It’s like filling a dry lake bed. Skin lubrication will restor e your skin’s moisture. How is this done? Just add water! Water alone will briefly moisturize your skin, but the new moisture is soon lost to the air by routine evaporation. How to prevent evaporation? Creams and ointments provide a protective film or coating of oil that prevents skin water from evaporating. This protective oil coating prevents dryness. Any type of oil can prevent water loss. Bath oils can be an effective way to prevent loss of moisture. You can rub bath oil onto your skin after a shower or bath. You can add it directly to your bath water: CAUTION: Slippery tub! When applying bath oil directly to your skin, first, soak in your tub and wipe your skin with a moist towel. Second, pour a small amount of bath oil into your hands. Liberally spread it around. Three large tablespoons of bath oil is enough for the entire body of an average adult male. If you prefer to use bath oil in the tub, after you have soaked for 10 minutes, add a tablespoonful of oil to the bath water and soak for 10 to 20 minutes more. Do not use soap, as you will be cleansed by soaking in the oil-water combination. After soaking, pat yourself dry with a damp towel. Enough bath oil will remain on your skin to prevent moisture loss. You can ask your pharmacist to show you OTC bath oils or mineral oil. The most important point to remember: Any skin lubricant is best applied after your skin has been wettened in the bath or shower, so as to trap and hold moisture in. Think of yourself as a bone dry sponge that has been soaked or dipped in water. The sponge is then dipped in oil to tightly seal the moisture in.

Treating Dry Skin Rash

When dry skin has developed into an itchy rash, a cortisone cream or ointment usually brings quick relief. The cortisone may be applied liberally to the rash and deeply massaged in, usually at bedtime, or after bathing, and one or two other times during the day. As your rash improves, the cortisone is decreased. Remember, dry skin requires topical therapy. Many patients would like to treat their dry skin with either a pill, an injection, or diet. Some patients have asked if fat intake improves dry skin. Excessive fat consumption can cause poor health. Please remember, when treating dry skin, there is no safe substitute for conscientious topical moisturization. If you want an oral cure, water is the best oral substance to help with dry skin. Pills aren’t available. Topical care is best. First, soak the water inside. Second, prevent evaporation with a film of oil. How about soap? Soap is bad for dry or atopic sensitive skin. Dial, Zest, Lever, Safegaurd, Ivory, gels, and Irish Spring are among the worst. Soap removes skin oils needed to hold in moisture. If oils are removed, the skin develops cracks, fissures, and dry inflammation. Soap should not be used on dry or sensitive skin. Most of us use far too much soap. Actually, plain water is often just enough to cleanse the skin. If you can't live without soap, it's OK to use Dove soap for your face, feet, armpits, and groin. What about bathing? Patients  may bathe or shower once daily using the following guidelines:

ABC Bathing Guidelines

Persons with atopic dermatitis involved skin may bathe or shower twice daily: 1. Use no soap on dry or sensitive skin areas. You may use mild  Gentle Face and Body Cleanser, instead of soap. 2. After bathing, thoroughly lubricate your skin using vaseline or a Replenishing Cream available OTC. 3. After your bath, you should not towel dry. Wipe off the water with your hands, then, apply a thick film of Cream to your entire body. This film will seal in your new moisture. 4. For shampoo, use OTC fragrance free Gentle Shampoo. Mild lubricants, or anti- pruritic creams, or mild hydrocortisone creams may be used all over the body to soothe the inflammation. Oral antihistamines may be used to reduce itching.

What about topical cortisone?

Topical cortisones should be used only when needed in the long time management of dermatitis, and should be tapered both in frequency of application and in strength. Only low potency corticosteroids, such as the various strengths and preparations of hydrocortisone, Acclovate, and Des Owen, should be used for longer than 10 days on the thin-skinned areas such as the face, neck, axillae, and groin, because of the increased risk of side effects of skin atrophy (thinning), depigmentation (loss of pigment), acne-like eruptions (particularly in the periorbital (around the eyes) and perioral areas, striae formation (stretch marks, especially in the groin), and, rarely, systemic corticosteroid effects. The use of more potent fluorinated or esterified topical steroids such as Psorcon, Temovate, Diprolene, Ultravate, Lidex, and Triamcinolone should be reserved primarily for limited application to exacerbated skin regions on other parts of the body. Systemic corticosteroids like prednisone or injectable Kenalog, should generally be avoided in all but the most acute and severe cases, and then they should be used only for very short-term, tapered courses. The need for topical corticosteroids may be reduced through the concurrent use of proper moisturization and avoidance of allergens like house dust, plants, cats, dogs, perfumes, and others. The treatment of acute flares of atopic dermatitis differs from that of chronic (long-term) dermatitis primarily in the way that the problem of hydration of the skin is approached. Dryness may be corrected in acute dermatitis by the addition of water to the skin followed by the application of a hydrophobic occlusive substance (Heavy Creams) or of occlusive wraps to retain the absorbed water. Although it is preferable to treat acute flares at home, in certain cases, hospitalization may be necessary, particularly when superinfection of weeping skin lesions is present. How to treat severe flares? Affected skin areas may be bathed for 15 to 20 minutes in tepid (never hot) water two to three times daily, followed by gentle patting with a soft towel after the patient leaves the bath, and immediate application of an appropriate heavy moisturizing cream or topical medication. Bath oils may be added to the water if done after the skin is thoroughly hydrated, and soothing substances such as Aveeno or sodium bicarbonate may also be added. Severely affected areas may be treated with wet wraps after bathing, to affect occlusion and thus maximize water absorption. If the face requires wrapping, this may be accomplished with two layers of wet gauze followed by two layers of dry gauze and held in place with Spandex netting. Such baths and compresses are frequently effective in removing crusts and reducing exudation. It is always important to apply heavy cream to seal in the moisture after the skin has been exposed to the water. For severely weeping lesions, Burow's solution (Domeboro available OTC), may be used with compresses, but should be limited to 2 to 3 days, as the Burow's solution is extremely drying and could lead to severe skin cracking and worsening of the itch. Topical corticosteroids are also used in conjunction with occlusive dressings in the treatment of acute dermatitis, again bearing all of the guidelines in mind which govern their use in long-term chronic management. Ointments tend to be more useful than lotions or creams in acute dermatitis, as they are more occlusive and thus provide better medication delivery to the skin. Ointments are less drying than lotions. Systemic corticosteroids, as noted before, are rarely if ever used in the treatment of acute dermatitis, but may be helpful. What about itch? The often severe pruritus (itch) which accompanies acute atopic dermatitis flares may be at least partially relieved through the use of antihistamines, like Atarax or Benadryl, around the clock if necessary, or, if those are not effective, tricyclic antidepressants such as amitriptyline (Elavil) may help. In addition, wet wraps are often quite effective therapy for nocturnal (nighttime) pruritus (itch). Topical lidocaine and topical Benadryl are not advised, as they can cause allergies after repeated use. What can be done about infections? People with atopic dermatitis are prone to skin infections, especially staph, yeast, and herpes. In general, infections are hard to prevent. However, many including staph, yeast, and herpes can and should be treated promptly to avoid aggravating the atopic dermatitis. Therefore, if you or your child has atopic dermatitis, learn to recognize the early signs of skin infection, and when you notice them, see Dr. Jacobs for treatment. Signs to watch for include increased redness, pus-filled bumps (pustules), and cold sores or fever blisters. Sometimes viral "colds" or "flu" cause flare-ups of atopic dermatitis. With extra skin care for a few days while the virus runs its course, severe worsening can be avoided. In cases of secondary skin infection (most frequently of severely affected, weeping skin lesions), appropriate cultures may be obtained and appropriate antibiotic coverage may be started. Although the bacterium Staphylococcus aureus is the most common causative organism, fungal and viral superinfections may also occur and should be appropriately treated if present. Topical Mupirocin (Bactroban) or gentimicin ointment may be used for very localized Staphyllococcal infections, but for infection of larger areas, systemic (oral) antibiotics are indicated. What about climate, heat, and humidity? Extreme cold or hot temperatures or sudden changes in the temperature are poorly tolerated by people with atopic dermatitis. In atopic dermatitis, high humidity causes increased sweating and may result in prickly heat-type symptoms, both of which may aggravate atopic dermatitis. Low humidity, such as when homes are heated during the winter, dries the skin. Unfortunately, humidifiers do not help much; the best protection against "winter itch" is regular application of a good moisturizer. While you can do little about the climate (and moving to a new climate is usually not recommended), you can try to keep the environment comfortable. For instance, keep your thermostat set low enough to prevent excessive room temperature, and avoid using too many bed-clothes that cause sweating during sleep. What about exercise? When a flare-up of atopic dermatitis is hard to control, it is wise to avoid strenuous exercise for a while. If you are sweating and starting to itch, slow down. Layers of clothing can be removed as needed to avoid overheating.

What about food allergies?

As many as 1 or 2 of every 10 children with atopic dermatitis suffer from some form of food allergy. Since an allergic reaction to food (either by skin contact during food preparation or by eating the food) can trigger a flare-up of atopic dermatitis, it is important to identify the foods to which a person may be allergic. Diagnosis of food allergies is extremely difficult. The easiest form of test is a blood test that Dr. Jacobs can order. There is also a skin test, where the skin is scratched with a small amount of the suspected allergen. If no inflammation results (a negative test), there is a good chance that the food will not affect that person. If the scratched area becomes inflamed the test is considered positive, but unfortunately, a positive result is difficult to interpret. First, a positive skin test is right only about 20 percent of the time. Thus, positive skin tests are only a clue to a possible allergy and should not be accepted as the last word. Second, because the skin of people with atopic dermatitis is so sensitive to irritation, simply scratching the skin can cause inflammation, making the likelihood of a false positive skin test even higher. Another type of test for food allergy is a blood test. As with skin tests, these have a very high rate of false positives. They are also expensive. For these reasons, they are not always recommended for allergy testing in people with atopic dermatitis. The only way to verify a positive skin test is to undergo a food challenge where the suspected food is eaten in a controlled setting. This proof can be complicated (and sometimes dangerous) and should be carried out only under the supervision of a physician. Warning: It is important to remember that simple elimination of all suspected foods may result in serious malnutrition. In children, unnecessarily removing nutritious foods from the diet can stunt growth. Consult the pediatrician about your child's diet.

Other Helpful Hints

Wear loose-fitting, cotton clothing: avoid wool and synthetics. Do not allow an atopic person to be vaccinated against smallpox. It can cause a life-threatening reaction. Try to reduce stress in your life if possible. Remove as many irritants from your life as possible. Do not adopt a cat or dog. Have a fish collection. Limit flowering plants both inside and outside of the home. When pollen counts are high, stay inside and change your air filter. If you do not have a good air filter on your heating and cooling unit, get one installed. Drapes, rugs, and other cloth furniture or decorative items will trap dust. Keep you environment as dust free as possible. Get rid of rugs and drapes as they collect dust. Stuffed toys do the same. Consider wrapping the mattresses in plastic to alleviate dust mites. Also, it is a good idea to wash all bedding frequently in hot water to remove dust mites. If you need pest control, always leave the house when chemicals are used. Better, put the wet chemicals outside and the dry chemicals behind baseboards, etc. Avoid fragrance products. Keep the Bounce, Downy, and fabric softener away. Keep the cosmetic products limited to Almay, especially in hair spray. Use unscented Tide in the laundry and double rinse. Wear natural fabrics. Always wash your new clothing before wearing. Avoid wool next to the skin. Rayon is not a natural fiber. It is a wood pulp derivative. It is not cool as cotton. What about food allergies? Food allergies may play a role in any atopic dermatitis. It is best to avoid foods which seem to cause increased itching. Some people can tolerate allergic foods in small quantities but break out when the amount of food eaten is increased. Test by eating only one suspected offending food at the time. If you have atopic dermatitis you are at higher risk of having an infection spread on your skin. If you think you are having an infection or fever blisters, call Dr. Jacobs. You may also be at risk for allergic reactions to drugs or foreign sera. Drugs should be prescribed with care. Dr. Jacobs will be happy to discuss this with you on an individual basis since the drug you need may be important and well worth the risk of allergy. Patients with atopic skin often improve with age, however, most will always retain an increased sensitivity to the environment. Knowing how to protect your skin is important. What about other allergies? Occasionally people with atopic dermatitis notice a worsening of their condition when exposed to certain things such as pets or dusty rooms. It is possible that an allergy to dust mites (tiny organisms present in household dust) may worsen atopic dermatitis in some people. As with foods, positive scratch and blood tests are not very reliable for diagnosing an allergy to these airborne substances. Research is being done on a type of patch test in which the suspected allergen is placed on the surface of the skin under a protective bandage. For now, however, the best approach is still the trial-and-error challenge method where the person first avoids the allergen and then is exposed to it while the skin condition is carefully observed. Treatment with allergy shots does not seem helpful for people suffering from atopic dermatitis. Sometimes the atopic dermatitis actually worsens during allergy shot therapy, even as the allergy symptoms are improving. What is the difference between irritants and allergens? Irritants are substances that are rapidly unpleasant or offensive, causing burning, itching, or redness. They include solvents, industrial chemicals, detergents, some soaps and fragrances, fumes and tobacco smoke, paints, bleach, woolens, acidic foods, astringents and other alcohol-containing skin-care products. If an irritant is potent or concentrated enough, it can irritate anyone's skin, whether they have atopic dermatitis or not, on the first exposure. In contrast, allergens are more subtle trigger factors. A person is never allergic to something the first time they use it. It takes many repeated exposures before the body can develop an allergy to a substance. Often, a person will say, “Dr. Jacobs, I can’t understand how I can be allergic to my perfume, I have been using it for 10 years.” Dr. Jacobs explains that the person has used the perfume for 10 years, and has finally acquired an allergy due to repeated exposure. An allergen does not irritate, but rather triggers a flare-up of atopic dermatitis only in a small number of people who have become allergic to the substance from prior exposures over time. Allergens are usually animal or vegetable proteins from foods, pollens, or pets. Everybody with atopic dermatitis must avoid the irritants. Those with known allergies should likewise avoid the allergen. Proving that someone is allergic  can be difficult.

What about emotional stress?

Many older children and adults with atopic dermatitis realize that stressful occurrences in their lives cause their atopic dermatitis to flare up. Anger, frustration, and embarrassment all may cause flushing and itching. The resultant scratching can cascade into a perpetuating dermatitis. People with atopic dermatitis can learn how to avoid stress-triggered flare-ups. Two key concepts are involved: 1. Coping with psychologically stressful events. 2. Controlling scratching behavior. Some suggestions that might help are: Establish regular structure for the behavior involved in skin care. Many people with atopic dermatitis have found it helpful to establish a schedule with a regular daily routine. In this routine, they include skin care along with all other activities of daily living such as brushing and flossing teeth or washing the dinner dishes. Yet, it is important to maintain a flexible attitude so that when the dermatitis flare and extra skin care is needed, it can be worked into the routine. It is important to recognize stressful situations and events. Before you can learn how to cope with the stress in your life, you must first notice when and how often stressful situations arise. These include day-to-day hassles as well as major events such as a job change, money problems, legal difficulties, family illness, etc. Ask yourself, "How do I react to stress?” “How does my body feel when I am stressed?" It is important to learn stress management techniques. Certain approaches to reducing stress can be done on your own, such as setting priorities and organizing your time. Some activities that may reduce stress and that need little or no professional guidance are regular aerobic exercise, hobbies, and meditation. A brief consultation with a psychologist can help you deal with stress. Keep a record in a diary of calendar of time and situations when scratching is worst, and then try to limit your exposure to such situations. Many people with atopic dermatitis scratch the most during idle times. Engaging in a structured activity with other people or keeping busy with activities that involve the use of your hands may help prevent scratching.

How to control dust mites?

The dust mite may be an important cause of eczema and asthma. The dust mite can only be seen with a microscope but it is nevertheless a common and significant cause of sensitivity. It may make the nose run or cause sneezing and wheezing. In some patients it also contributes to exacerbations of atopic dermatitis. A dust mite   The dust mite hides in the dust that can be found in even the cleanest bedroom - deep in carpets and curtains and in the seams of mattresses, where even the most house-proud individual can't find it. Bedding  The dust mite is choosy and prefers wool and cotton to artificial fibers. So you can deter it by using only synthetic bedding materials, and by washing all sheets every week.  A duvet - continental quilt - reduces laundry, but feather, down or flock fillings must be avoided in these and in pillows.  The dust mite's favorite haunt is bedding, particularly mattresses. Measures to reduce the numbers of house dust mite. Special mite resistant covers for pillow, mattress and duvets can be purchased.  Sunlight destroys the dust mite. In the summer, put your blankets and mattresses out in the sun and make the most of the sunshine to dry out your sheets and pillowcases. Put soft toys in the freezer for a few hours.  Use a vacuum cleaner Daily use of a vacuum cleaner will help to reduce the amount of dust containing the mite. Vacuum all carpets, especially in the bedrooms and under the beds. If you can, choose vinyl flooring rather than carpet as it tends to hoard less dust. Vacuum upholstery and curtains, and don't forget the mattress and blankets. Wash curtains regularly. There is less dust when curtains are made of lightweight materials. They also need to be vacuumed often, and wash them regularly too (perhaps six-weekly). Be tidy  Put clothes away in wardrobes, and that includes the dressing gowns! Use a da p duster to do the cleaning as it is much better at collecting dust than a dry one. Dehumidifiers can inhibit house dust mites, as they prefer a moist environment.

What To Expect

In discussing the management of both acute and chronic atopic dermatitis, it is important to bear in mind that atopic dermatitis, is a disease for which there is no real cure. Atopic dermatitis can only be controlled. Atopic dermatitis, does, however, usually improve on its own, spontaneously as the patient reaches early adulthood. The extent of this improvement tends to depend upon how severely affected the patient was during childhood. Studies have shown persistence of severe atopic disease into adult life ranging anywhere from 10% to 70%. Many people who do show improvement in their eczematous disease do, however, go on to develop asthma and/or allergic rhinitis (hayfever). Additionally, the three conditions asthma, hay fever, or atopic dermatitis may also coexist indefinitely. If you have any other questions, please ask Dr. Jacobs at your next visit.