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Atopic Eczema, Atopic Dermatitis, Infantile Eczema

The term atopy was originally used to describe a group of patients who had a personal family history of hay fever, asthma, very dry skin and eczema. There is an unexplained association between these other diseases and atopic eczema, which is thought to be hereditary. In many countries, such as Australia, the terms “dermatitis” and “eczema” are interchangeable. However, in some countries, the terms may have slightly different meanings.

Atopic dermatitis is usually seen as reddish, itching skin, or it may be oozing and crusty. It generally begins early in life. Because the skin inflammation often begins between 1 and 4 months of age, it is commonly called “infantile eczema”. Atopic dermatitis follows a pattern of flare-ups and remission. Almost any part of the body can be affected at any time, but the distribution tends to follow distinct patterns during infancy, childhood and adult life.

Infant Phase
Atopic dermatitis usually begins on the face, most often on the cheeks, and the chin is also commonly inflamed. As the baby begins to crawl, thickening of the skin on the knees and ankles takes place. Crusting and scaling of the lips and peri-oral area may be due to lip-licking, thumb-sucking or dribbling. A small number of infants have a generalised eruption, however the nappy area is often spared. Repeated scratching may lead to lichenification. In the majority of cases, the dermatitis clears by the age of 2 to 3 years, but may recur later, at intervals.

Childhood Phase
During childhood, the dermatitis occurs mostly in the folds of the knees and elbows and sometimes around wrists, ankles and neck. Thickening and darkening of the skin is often noticeable, but regularly affected areas may be paler. The face and neck usually improve, but dermatitis may continue behind the ears and around the eyes. At this time, secondary infection is more common. Caution should be taken if possible, to avoid infection with viruses such as herpes simplex. Exacerbating factors are sweating, heat, cold, dry air and emotional stress.

Adult Phase
The adult phase of atopic dermatitis begins near the onset of puberty. The dermatitis frequently returns to the face and neck and persistence in the flexures is common. Hand dermatitis is the most frequently seen symptom and the eyelids are often thin and inflamed. After middle age, the atopic dermatitis usually diminishes, sometimes becoming a chronic dermatitis of the hands and feet. A few people continue to suffer throughout life. In adults, thickening of the skin may take place, often due to repeated episodes of scratching and healing.

It is not unusual to see areas of skin with no sweating, probably due to blockage of the sweat ducts. This exacerbates the problem during hot and humid weather and for those participating in physical exercise. Sudden changes in temperature and emotional stress may also induce flare-ups. A simple diagnostic test for atopic dermatitis or eczema is to press the affected skin gently but firmly. If the redness temporarily disappears and the skin appears white, this suggests a diagnosis of atopic dermatitis. If the skin does not show whitening, and there is no family history of atopy, then seborrhoeic dermatitis or some other dermatitis is a more likely diagnosis.

The first aim of the treatment should be to make the patient as comfortable as possible to avoid the damage caused by scratching. Restoring moisture to the skin increases the rate of healing and helps to protect the skin from further drying and irritation. The use of emollient bath oils and moisturising treatments should be recommended to the patient to achieve this. To treat flare-ups of atopic eczema (dermatitis), use QV Flare Up Bath Oil, an antibacterial moisturiser daily.

1. AVOID SOAP
Soap removes the skin’s layer of natural oils, causing the skin to dry out. Most soaps have an alkaline pH which strips away your skin’s natural protection, leaving the skin exposed to infection. Ordinary soaps should be replaced with QV’s gentle non-soap cleansers such as QV Wash or QV Bar. These refresh your skin and have pH similar to your skin’s pH so they are less likely to irritate your dry or sensitive skin. They help to maintain the skin’s natural protective properties.

2. MOISTURISE FREQUENTLY
Repair your skin with QV Skin Lotion or QV Cream, which help to restore your skin’s moisture by sealing in your body’s own moisture. They also add further moisture to relieve the dryness of your skin. Like all QV products, QV Skin Lotion and QV Cream have a pH of 6 to maintain the skin’s natural protection.

3. MOISTURISE ALL OVER
Revive your skin by moisturising all over with QV Bath Oil, especially if you have large areas of dry or sensitive skin. By following this simple three-step plan, you can repair, revive and refresh your dry or sensitive skin. Importantly, the QV range also seals in moisture to make sure that your skin feel fantastic throughout the day.

Advice for the Patient

1. Many atopic dermatitis sufferers are infants so there are at least 2 patients: the infant, the mother and any other person caring for the baby. The parent needs to be reassured, calmed and inspired with confidence by telling her the cheering facts:
(a) Most babies recover by the time they are 2 - 3 years old, and that no marks or scars will remain.
(b) It is not contagious.
(c) The baby is basically healthy.

2. As environmental factors play a big part, the following measures will assist recovery:
(a) Overheating should be avoided.
(b) Clothing should be loose and light. Avoid wool, synthetic or rough material next to the skin. Soft cotton is more suitable.
(c) Avoid using soap, products containing lanolin, and perfumed products. Repeated rinsing of clothing, bed-linen and napkins to remove all traces of soap or washing powder is important.
(d) After bathing or showering, gently pat skin dry, do not rub.
(e) Dry skin should be treated with emollients.
(f) The feeling of roughness in clothing, particularly woollens or jeans, may be relieved by adding a fabric softener to the final rinse.

3. Learning to relax and removing causes of tension, will help to prevent flare-ups of dermatitis and eczema. Therefore, interested assistance and kind reassurance are important to the sufferer, as an aid in developing relaxed state of mind. This helps recovery. Once the patient has learnt to control their eczema (by suitable creams, washing procedures, and a more relaxed attitude), he or she will know how to help prevent or treat any recurrences.

4. Treat underlying infection that is associated with flare-ups of Atopic Eczema. To treat dry or sensitive skin thoroughly and effectively, a complete moisturising routine is necessary.

Products to Help (Moisturising Soap Alternatives)

QV BATH OIL
This water dispersible oil is the most effective way to revive large areas of dry or sensitive skin. Treat and protect your skin while relaxing in a bath. For adults, add 2 capfuls (20 mL) to a 20 cm bath and soak for 10 to 15 minutes. Do not use soap. QV Bath Oil is also available in a handy shower pack, as most people do not have time to luxuriate in a bathtub every day. QV Bath Oil leaves the skin feeling soft and smooth with a healthy glow.