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My wife once told me that she suffered from the skin condition atopic dermatitis
as a child. I had never even heard of it before that, let alone known what it
looks like. She does not show any symptoms today. Now our two-year-old daughter
has an itchy rash on her face and neck and the doctor said it is atopic
dermatitis. Is the condition genetic? What can be done to treat it? Will it go
away, as it did in my wife’s case?
N.T., Petah Tikva
Dr. Ya’acov Mashiah of the
pediatric dermatology department of the Dana Hospital at Tel Aviv Sourasky
Medical Center replies:
Atopic dermatitis is a chronic skin condition with
eruptions characterized by itchy and dry skin and rashes. It can occur at any
age from infancy through adulthood, but the incidence and the severity decline
as time goes by, usually by the end of the teen years. Eighty percent of
new cases occur by the age of five.
The skin condition can be very
frustrating, but in most cases the severity declines with age; only a small
percentage of people who suffered from it as children continue to suffer from it
as adults. The bad news is that it not a pleasant disorder, but the good news is
that it usually passes – as your wife has probably noticed by now. So don’t give
Atopic dermatitis is, indeed, more common in children with a
parent or parents who had it; this phenomenon occurs in as many as two-thirds of
cases. A number of genes have been found that, if damaged, will result in atopic
dermatitis. However, it is still not possible to precisely characterize the
genetic reason for the disease, which may be connected to a number of defects
that cause the same symptoms. Most atopic dermatitis patients or their close
relatives suffer from hay fever or asthma as well.
Despite much research
in the field, there is no absolute answer. The conventional one is that the
condition is a combination of genetic tendencies, a defect in the immune system
and a failure of the skin to guard against all external attacks. This is
expressed by dryness, excess sweating and, as a result, itching. The skin
can then easily be penetrated by external elements such as allergens and
Beyond internal factors, there are certain other external
influences that can cause an attack or exacerbation of atopic dermatitis. These
include emotional stress, dry and hot weather, infectious agents such as
bacteria and viruses, and cleaning materials that irritate the skin. The
environment where you reside may also affect the condition, as, for example,
living in an industrial area.
Most complaints are about the itching and
scratching, which can be insufferable and cause lack of sleep in some people.
The rash is comprised of small raised spots on the skin that turn into red
patches which sometimes grow scales. As the skin is very permeable, secondary
infections can occur, causing the skin to become thick and rough.
the rash occurs depends on one’s age. In children, it can appear on the cheeks,
scalp and neck; the diaper area is usually not affected. In youngsters, it
appears most often in the folds of the neck, behind the knees and inside the
elbows, at the base of the palm and on the ankles. In adults it is usually found
on the face, neck, chest and limbs.
Atopic dermatitis cannot be
eliminated with one treatment. Treatment depends on the stage in which it
appears and how serious the condition is. One of the important rules is hygiene.
As it can worsen during skin infectious, the body must be kept
It’s best for the child to take a bath with bath oils rather than
a shower. The water should be warm but not too hot, as this may cause itching.
Dry the skin by sponging up water instead of rubbing it. Several times a day,
apply a skin cream that prevents the skin from getting dry. Cotton clothing that
is light and airy is better than wool. The ambient temperature of the bedroom
should be 24ºC with moderate humidity.
There are medications, depending
on the situation; drugs should not be given automatically. Steroid creams are
frequently used, but they have to be applied carefully to avoid side effects.
Antibiotic salves may also help fight infections.
that modulate the immune system may be prescribed, but not on large areas of
skin and without significant absorption. In some cases, these will not be
enough, and oral treatment with antihistamines may be required. In the worst
conditions, phototherapy – solar radiation at certain wavelengths – can be
effective. This is not radiation that causes growth, but the use of a small part
of the solar spectrum. In severe cases, the antirejection drug cyclosporine –
given to organ transplant recipients – is given.In your response to the
question about coffee in a previous column, you expounded on the benefits of
caffeine, but related it only to coffee. However, this reader clearly stated
that he “prefers drinking tea” and that the taste of coffee “doesn't really
appeal” to him. Could you discuss the benefits of drinking black, white and
green teas as an option for this person, who clearly wants to reap the health
benefits of drinking hot caffeinated beverages? C.W., ElazarDorit Adler, chief
clinical dietitian of Hadassah University Medical Center in Jerusalem’s Ein
Tea – especially green and black teas – is a recommended
caffeinated beverage, and there is evidence of its antioxidative
There are studies that have shown that three cups of such tea a
day reduces the risk of stroke, while other studies found that drinking green
tea correlated to reduction in heart disease risk, inflammatory processes and
even mortality risks. Thus these kinds of tea can be regarded as part of a
recommended protective diet.Rx for Readers welcomes queries from readers
about medical problems. Experts will answer those we find most interesting.
Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your
question to Judy Siegel- Itzkovich at (02) 538-9527, or e-mail it to
firstname.lastname@example.org, giving your initials, age and place of residence.