Eczema is a chronic inflammatory skin condition. It is known as the “itch that rashes.” It can go by different names, depending on what is triggering the skin to become inflamed. Atopic Dermatitis is caused by an allergy to either a food or airborne allergen. Contact Dermatitis is secondary to a chemical causing inflammation. Irritant Dermatitis is often from abrasion of the skin, such as excessive handwashing or exposure to chemicals. Control of eczema includes a combination of allergen avoidance along with medications (typically topical). The goal is to identify the trigger and eliminate the need for medications. Moisturizing the skin on a regular basis is very important for people with eczema. Topical steroids, calcineurin inhibitors and skin barrier emulsion creams may be necessary to treat areas of inflamed skin. In people with more severe eczema, other treatment options include oral immunosuppressant medications and allergen immunotherapy.
Atopic dermatitis typically starts in childhood, but can first occur in adulthood as well. It often leads to severe itching. Atopic dermatitis can be triggered by various allergens including foods and environmental allergens (i.e dust mites). Allergy testing will help identify the triggers. The mainstays of treatment for Atopic Dermatitis are identifying the trigger, strict avoidance, and topical therapies. In moderate to severe cases of atopic dermatitis in adults not controlled with avoidance measures or topical therapies, dupilumab (Dupixent) is an injectable medication given every 2 weeks that targets a specific inflammatory mediator in atopic dermatitis.
Contact dermatitis is a type of hypersensitivity reaction to a substance that comes in contact with the skin. Common examples of contact allergens include nickel, fragrances and latex. Poison ivy (Rhus Dermatitis) is an example of a type of Contact Dermatitis. The rash of contact dermatitis is very itchy and appears either as red bumps or blisters. Contact dermatitis can be diagnosed via patch testing. This helps identify a specific chemical that is causing the inflammatory response on the skin.
Urticaria, or hives is a skin rash characterized by raised, red, blanching lesions. Each hive typically lasts less than 24 hours, but a person may have hives for hours, weeks, months, or even years. Hives lasting less than 6 weeks is called Acute Urticaria. Typical triggers for Acute Urticaria include food allergies, medication allergies, or a viral infection. If you experience hives, we will take a comprehensive medical history in order to identify the underlying cause. If appropriate, allergy testing may be performed. Daily hives lasting more than 6 weeks is called Chronic Urticaria. When a patient meets the diagnostic criteria for Chronic Urticaria, allergies become a much less likely cause of the hives. We need to consider the hives as a presentation of an underlying medical condition. Therefore, we will order laboratory testing to assess for any possible causes of the hives such as an autoimmune or infectious condition. Treatment of hives includes eliminating or treating any underlying cause. If an underlying reason for the hives is not identified (Chronic Idiopathic Urticaria), symptomatic treatment is appropriate. Medications used to treat Acute and Chronic Urticaria include antihistamines, H2-Blockers, leukotriene antagonists, and anti-IgE therapy (omalizumab).
Angioedema is defined as swelling without itchiness or significant redness. It can be caused by medications. ACE Inhibitors are a group of medications commonly associated with angioedema. Aspirin and NSAIDs can also lead to swelling. Angioedema can occur as part of an underlying diagnosis such as Hereditary Angioedema (HAE) or Acquired Angioedema. These conditions occur secondary to a deficiency or defect in an enzyme called C1Esterase Inhibitor. Treatment of Angioedema depends on the underlying cause.