Atopic Dermatitis: Allergic Eczema Treatment
There's More to the Puzzle
In this article I will relate a personal experience with atopic dermatitis in an attempt to show a pattern of symptoms. Intertwined will be medical material gleaned from research on the Internet.
The interest I have in this topic derives from what I initially thought was a voodoo type diagnosis based on strange procedures. In truth, I thought the doctor who first helped me with an acute outbreak of atopic dermatitis had had too much to drink.
That Red Sign Spelled Relief
When I was 19 (in 1969) and serving in the U.S. Navy, I woke up one early morning about 1:00 a.m. feeling a bit warm and itching all over. I sat up in bed and thought it might go away if I sat still and relaxed (don't ask me why I thought that), but the problem worsened. The itching was terrible, and I was scratching myself red all over. I could see that there was a rash over my chest, back, and arms. Soon it was obvious I needed some help.
Luckily for me, I was stationed at the U.S. Naval Hospital in San Diego, California. What a great place to work when you have an itch! It was just a skip and a jump from the barracks to the emergency room where I quickly headed. By now I could tell my arms were a bit puffy and the rash no longer looked like heat rash; it was a light red, raised, and no longer had red spots. The itching was stupendous and nothing I had ever experienced.
So there I sat, not unlike today at urgent cares or E.R.s, trying to rub the rash to get some relief as I could tell scratching was really aggravating my skin.. It was impossible for me to ignore it even while I knew I should. It is amazing how much you can look forward to seeing a physician during times like those. This had never happened to me. Unfortunately several people had been in car and motorcycle crashes and I was going to have to wait my proper turn. It seemed like an eternity.
When I got in to see the doctor he had me remove my blouse (that's a shirt in the Navy!) and undershirt and said, "Oh, boy!" I related that I had had no warning - when I went to bed I wasn't warm, had no rash, and felt fine. Then the doctor's voodoo started. Perhaps you can relate, and if you are reading this because of a friend or loved one the narrative might give you some insight.
The doctor had me hold out my right forearm. He proceeded to drag his fingernail over my skin with just a gently pressure, enough to cause a slight scratch. I noticed nothing. But he said, "Ah,ha! White dermographism." It turned out that after the redness showed from the scratch, the center showed up white. This, I learned, can correlate to atopy, another name for atopic dermatitis. Other names include: infantile eczema; atopic dermatitis; dermatitis - atopic; eczema - atopic. This kind of eczema most often occurs in children, but many outgrow it before the age of 10. If it continues into adulthood it is most frequently a chronic condition. It can occur initially while an adult. Women suffer from this kind of eczema fractionally more than males.
At this point the doctor had me sit on the examining table and said, "Open your mouth, sailor!" I saw a tongue depressor and said, "Sir, I don't have a sore throat, I itch." His response was, "Open your mouth!" So I opened it. He put the stick in my mouth and seemed to be poking around in there. It was odd. What in the world was he doing? Then I felt the stick against the back of my throat. He gently poked it around the back of my throat and then withdrew the thing looking rather pleased.
"You have no gag reflex" he related with a tone indicating certainty.
There are times in life when you can't hardly help yourself. I wanted to say, "So what? I itch horribly!" But then you realize who you are, where you are, and whom you are talking to.
Another characteristic of people who have atopic dermatitis is the absence of or presence of a reduced gag reflex. No kidding. There is a correlation between that and people with this eczema. The dermatitis, from my reading, has many common symptoms to other eczemas, so diagnosing depends most often on a good history and specific conditions noted. Along with the 2 peculiar things already noted there are other considerations the doctor takes. Though skin rashes with redness, swelling, itching, etc can occur in many eczemas, there are three things that atopy patients usually have in common which set them apart. They are: eczema, allergies, and asthma. All of these need not be present at once.
I Suppose I Did Have An Allergy
The doctor then started to ask me about allergies. I told him I didn't have any to my knowledge, but when it was a little warm, as in spring (the time of year this all happened), if I wore wool I would break out in a rash. When I was a kid and had to wear something wool I would sneak a cotton shirt to school and change in the bathroom. I hate wool, it always makes me itch! Of course, Navy uniforms were made of wool. One of the common allergies associated with atopy is to wool. Later I bought a gaberdine uniform and avoided coarser wool like the plague. From Wikipedia, gaberdine is the fiber used to make the fabric and is traditionally worsted wool but may also be cotton, synthetic, or mixed. I got cotton. It worked out for me for 4 years.
As a kid I had had acute bouts with skin rashes and eczema which lasted only a short period of time. My parents would have me clean up, put Vaseline on the area, and keep doing that. Soon it would go away. I never saw a doctor about it. I was lucky! No one had asthma in my family and neither did I. One component of atopic dermatitis is genetic. Nearly all patients have mothers, fathers or siblings with allergies and asthma. My mom was allergic to a host of things.
After giving him all the history he wanted he said, "You have atopic dermatitis". Then the Lt. Commander said, "I have just the thing for you." He left and came right back with a syringe. So I got a shot of something in the butt and some pills along with a cream. I don't remember what the eczema cream was, but the shot was Vistaril. Recall that with eczema the most important issue is to get control of the itching to stop the scratching which just makes things worse and can lead to weeping, crusting, and infection. Vistaril is used to relieve itching from allergy. There may be antihistamine or other drugs that work better now to reduce itching, but Vistaril was what the doctor chose back then. He sent me off with pills that he said were like the medicine he injected and to take them according to a regimen I cannot remember now. I assume the medication was Hydroxyzine (generic) or ATARAX Hydrochloride (brand name) based on articles I have read. Vistaril is the injectable form of the drug. This was my dermatitis treatment, and now I know the doctor was not imbibing.
His parting words to me were comforting, "You'll be feeling a lot better soon, son." Shortly thereafter the itching really did start to subside, and I thought that doctor was the smartest man on earth. Even with all the hocus pocus, he sure knew what he was doing.
Later on when I had the money to buy a car, I discovered that when gas splashed on me, I almost immediately got a rash that would develop the same way. Quickly washing it and patting it dry and using an eczema cream I had gotten from another doctor helped it resolve pretty soon. Who knows if that was atopic dermatitis, or a different allergic reaction? These things must be determined by a physician who has the knowledge and a keen eye. I am just thankful that whatever it is, it is mild in me.
Atopic dermatitis is frequently, in the literature, referred to as an inherited trait. Some of the other things that can spawn a reaction are: dry skin, seasonal allergies, harsh soaps and detergents, new skin products, and cold weather. I have also read that depression can be a component, although the verdict is split about that. Each patient has his own set of symptoms, while the symptoms and severity of the disease can change over time.
A preliminary diagnosis of atopic dermatitis can be made if the patient has three or more characteristics from each of two categories: major features and minor features.
In diagnosing atopic dermatitis, there should be two categories of characteristics, major and minor. Within major and minor categories, there should be three or more characteristics. From medicinenet.com, the following chart contains the characteristics.
Major and minor features of atopic dermatitis
Characteristic rash in locations typical of the disease (arm folds and behind knees)
Chronic or repeatedly occurring symptoms
Personal or family history of atopic disorders (eczema, hay fever, asthma)
Some minor features:
Early age of onset
Dry, rough skin
High levels of immunoglobulin E (IgE), an antibody, in the blood
Ichthyosis(mostly genetic skin problems with dry, thickened, scaly or flaky skin.)
Keratosis pilaris (a common skin condition in which a protein in the skin called keratin forms hard plugs within hair follicles)
Hand or foot dermatitis
Cheilitis (dry or irritated lips)
Susceptibility to skin infection
Positive allergy skin tests
If you are a parent dealing with a child who has this condition, eczema treatment is a team exercise between the parent, physician, and child. I highly recommend reading the article designated below.
Treating eczema requires awareness and discipline, but can be managed thanks to a core of drugs and the physician's knowledge.
Treating the child
- Atopic Dermatitis (Type of Eczema) Causes, Symptoms, Treatment and Diagnosis on MedicineNet.com
Get information on atopic dermatitis (a type of eczema) causes, symptoms, diagnosis, management, treatment and medications. Learn if this itchy skin rash is contagious.
Co-morbidity (other medical conditions) Associated with Atopic Dermatitis
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2010 John R Wilsdon