Atopic Dermatitis (Eczema)

Atopic dermatitis is an inflammation of the skin characterized by itchy, red, dry, and cracked skin. It typically starts in childhood with symptoms waxing and waning with age. In children, the rash typically appears in body creases, such as the the back of the knee and and front of the elbow. In adults, hands and feet are the most commonly affected areas. Scratching causes increased risk of skin infections and scarring.

Atopic dermatitis is caused by a complex interplay of genetics, immune system abnormalities, environmental factors, and compromised skin barrier. It often coexists with the “allergic triad” of allergic rhinitis, atopic dermatitis, and asthma. Allergy testing for inhalants and foods may need to be performed to evaluate the cause of the dermatitis. The offending agents can thus be avoided or not consumed. Allergy injections or SLIT can be initiated to desensitize patients. Chemical irritants, dry weather, stress, soaps, fragrance, and scratchy fabrics can exacerbate symptoms. Initial treatment includes appropriate bathing, moisturizing cream, topical steroids, and medications for itching. Those with persistent symptoms may be prescribed other treatments such as calcineurin inhibitors, biologics, and phototherapy.

Hives and Angioedema

Hives are a type of rash that present as raised, itchy bumps that are typically mobile. They tend to last a up to a few days. If they last for more than six weeks, they are considered chronic idiopathic urticaria. They commonly occur in response to an infection or an allergic reaction. Less commonly, they can be secondary to physical stimuli (temperature / vibration), autoimmune disorders, and lymphoma. Having asthma or allergic rhinitis increases the likelihood of getting hives. Treatment includes avoidance of the allergen, oral antihistamines, steroids, epinephrine, intubation, and leukotriene inhibitors.

Appropriate evaluation is necessary. If found to be idiopathic in nature, oral treatments can be initiated. A small number of patients will require biologic medication that can be administered in the office monthly to control the outbreaks.

Angioedema is swelling of the lower layer of the skin, presenting in the face, tongue, throat, abdomen, or extremities. The cause of angioedema can be allergic in nature – an accumulation of histamine in response to foods, insect bites, or medications. Another common cause is a category of medications called ace inhibitors, which are typically prescribed for hypertension and heart disease. Hereditary angioedema, also known as C1 esterase inhibitor deficiency, is possible but less common.