Atopic dermatitis or eczema is a chronic inflammatory disorder of the skin that can range in severity from scattered, mild patches to very severe itchy, red, rash that can affect all of the skin. In people with eczema, even normal looking skin can be very itchy. Eczema is sometimes called the “itch that rashes” because itching leads to scratching that can worsen eczema and lead to more itching. It is important to identify environmental allergens that may be contributing to eczema. Food allergies can contribute to severe eczema, but in general, before broad food allergy testing is done, the skin care regimen should be optimized.
The skin of people with eczema has a dysfunctional barrier that makes it hard to retain moisture. Good regimens for eczema generally involve daily baths (soaking for 15-20 minutes) using a non-soap cleanser such as Cetaphil followed by patting the skin dry and then applying topical steroids to active, eczema lesions. The rest of the skin should undergo very aggressive moisturizing. Moisturizers can be applied several times per day. Plain, unscented petroleum jelly is often the best option to use on the skin for most individuals. The better the basic skin care regimen, especially using petroleum jelly or simple moisturizers (avoid scented lotions and those with too many ingredients), the easier it is to prevent flares of eczema and itching. In severe cases, bleach baths (2-3 days/week) and wet wraps may also be considered.