Atopic Dermatitis or Eczema.  Itchy, dry, red, crusty, flaking, blistering, cracking, oozing, or bleeding skin.  Most people think it is just a skin problem.  You might not know that the majority of children with eczema have allergic eczema driven by allergies to foods or their environment.  They may respond to allergy testing and treatment.

Identifying eczema is important because it is often the first manifestation of the “allergic march”, leading to hay fever and asthma if unchecked.

Eczema is particularly noticeable on face and scalp, neck, inside of elbows, behind knees, and buttocks.  Eczema has a hereditary component and often occurs in families with hay fever and asthma.  Allergic diseases such as eczema are a rapidly growing health problem.  The incidence is rising, especially in developed countries.

History is important in diagnosing eczema.  Family history, diet, lifestyle, allergy history, prescription drugs, chemical or material exposure at home or work are clues to the cause.

To determine whether eczema is the result of an allergen, your allergist may recommend skin testing.  This is a precise, reliable test for IgE antibodies to specific substances.  In skin testing, a tiny amount of the suspected allergen is put onto the skin or into a testing device that pricks the top layer of skin. This puts a small amount of the allergen under the skin. A hive will form at any spot where the person is allergic. This test generally yields a positive or negative result. It is good for quickly learning if a person is allergic to a particular food or not.

In addition, your allergist may test your blood for the levels of antibodies and the numbers of certain types of cells. In eczema, the blood may show an increased number of IgE or eosinophils.  Both tests are valuable tools in making the diagnoses of allergy, prescribing treatment, and predicting disease development.

Another test for eczema is skin patch testing. The suspected irritant is applied to the skin and held in place with an adhesive patch. Another patch with nothing is also applied as a control. After 24 to 48 hours, the patch is removed. If the skin under the suspect patch is red and swollen, the patch test result is considered positive and suggests that the person is probably allergic to the suspected irritant.

Occasionally, the diagnosis may also involve a skin biopsy which is a procedure that removes a small piece of the affected skin that is sent for microscopic examination in a pathology laboratory.

Skin tests, blood tests and biopsies are not always necessary for eczema diagnosis. However, doctors will sometimes require them in order to identify particular triggers.

Treatment for eczema includes removal of allergens first and foremost.   This means identifying allergies is key.  Other acceptable treatments include moisturization, gentle cleansers, itch relief medication, environmental and behavioral modification, corticosteroids, antibiotics, immunomodulators, immunosuppressants, light therapy, and alternative therapies.

What else can you do?  Studies suggest that delaying the introduction of solid foods until 4-6 months of age and breastfeeding for at least 3 months may decrease one’s chance of developing eczema.  Current research is looking into herbal and skin cell growth factors as new treatment approaches for recalcitrant eczema.