Person scratches arm with rash of atopic eczema

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This is how you should treat the skin disease atopic eczema

Atopic eczema, atopic dermatitis, is a chronic and recurrent skin disease. It is a very common condition in young children, therefore it is also often called childhood eczema. The symptoms of atopic eczema may be slightly different in children and adults.

The severity of atopic eczema varies, and some experience only a few small areas of skin that itch a little, while others get more violent rashes over larger areas.

In babies, eczema is most often made up of small, oozing blisters on the cheeks and scalp. In young children, eczema is usually drier and has often been scratched, while in adults it is most common with dry and itchy skin.

Most people with atopic eczema will find that the condition fluctuates between good and bad periods. Eczema is often at its worst during the winter months due to low humidity and the fact that the skin is drier than usual.

What is the cause of atopic eczema?

If we look at the causes behind atopic eczema, we see that heredity plays an important role. If one or both of your parents have eczema, there is a greater chance that you will also get atopic eczema.

The disease itself is caused by a defect in the skin barrier and a defect that causes the immune system to overreact. A mutation has been detected in the natural fat, filaggrin, which in normal skin lies between the skin cells in the epidermis and forms a protective barrier.

The epidermis becomes leaky and cracks often form which increase the risk of secondary infection, as well as the risk that substances from the outside penetrate deeper into the skin.

Filaggrin also helps maintain moisture in the skin. People with a detectable filigree mutation therefore have an increased risk of developing atopic eczema. All patients with atopic eczema have a reduced skin barrier function and filaggrin deficiency.

Often it is a combination of heredity and environmental factors that triggers the eczema.

It is also clear that there are risk factors that can trigger or worsen the rash once you have the disease. Especially in infants with severe eczema, it is seen that certain foods can aggravate the eczema. This applies to foods such as milk, eggs, soy, wheat, fish and nuts.

Disease course and symptoms

Atopic eczema is a chronic, recurrent dermatitis. The condition is most common in children under 5 years of age, but can occur at any age.

About 3% of all infants develop atopic eczema. About 10-20% suffer from school age, while only 2-3% of adults still have atopic eczema. We can still say that this is one common skin disease in Norway. There is no difference between the sexes in incidence.

If you have, or have had, atopic eczema, there is also a greater risk that you are or may be bothered by asthma or allergies, especially hay fever. The term atopic diseases is used for atopic eczema, asthma and hay fever.

Even though many people get rid of the specimens during childhood, you will always have dry, atopic skin type. Therefore, good skin care is important for the rest of your life. Around 25-40% of those who have had atopic eczema as a child relapse as a young adult, and around 30-55% develop hand eczema in adulthood.

Epidemiological studies conducted worldwide show that the incidence of atopic diseases has increased in recent decades. This can be caused by changes in the environment and lifestyle, especially in the western world.

Atopic eczema and other diseases

If the eczema starts early and is particularly severe, this is a predictor of later respiratory allergies and hand eczema.

All children with atopic dermatitis should be evaluated for allergy, but allergy testing should only be performed if the effect of treatment is absent, or if the child has several symptoms at the same time (skin, lungs, nose, eyes, stomach and intestines).

In patients with atopic dermatitis, there is an increased risk of infection with the development of yellow staphylococci, an increased risk of severe herpes simplex virus and the development of mollusks (water warts).

Recently published research has also shown that patients with severe atopic dermatitis have an increased risk of developing cardiovascular disease, autoimmune diseases and inflammatory bowel disorders (especially Crohn's disease).

For this reason, the doctor will often motivate patients, especially those with severe eczema, to lead a healthy lifestyle with exercise and possible smoking cessation.


The disease causes dry and itchy skin, often with rashes. It is especially common to get eruptions in the flexor grooves on the body, ie in the elbow flexors and in the kneecaps.

The rash occurs on limited areas with swelling and small blisters. In the chronic stage, the rash will lead to thickening of the skin.


Infants usually get eczema rashes with small oozing blisters on the cheeks and scalp. They can also erupt in the diaper region and on the stretch side of the arms and legs.

Little children

In young children, the eczema is drier and often cleared up. Therefore, it is important to keep children's nails short to avoid this. The rash is often symmetrical on the body, arms and legs. The rash most often occurs on the flexor sides of the joints, ie in the kneecaps and ankles, elbows and wrists. Children can also have cracks in the earlobes and dry, chapped lips.

Grown ups

Adults with atopic eczema generally experience dry and itchy skin. Due to itching, the skin may also thicken in some areas. Symmetrical eruptions can also occur on the upper body, on the flexor side of the joints of the arms and legs, and in the face. Then especially around the eyes.

Redness and flaking may also occur on the face and neck as a result of fungal infection with pityrosporum ovale. Larger amounts of yeast can provoke eczema by causing an immunological, irritating reaction.

In adults, atopic eczema is most often seen at the age of 18-40 years, and often has a chronic course.

In addition to the eczema rash itself, bacterial infections can occur. These occur because the skin's barrier against infections is weakened by eczema outbreaks. If you get such an infection, you can recognize it on yellowish crusts that occur in the eczema rash.

Diagnosis of atopic eczema

The diagnosis of atopic eczema is made based on the medical history, the appearance of the rash and where it is located on the body.

The definition of atopic dermatitis is itching, as well as at least three of the following symptoms:

  • Eczema in buoyancy.
  • Dry Skin.
  • The child has asthma or hay fever, or the immediate family has asthma, hay fever or childhood eczema.
  • Eczema occurs before the child is 2 years old.

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Treatment of atopic eczema

Treatment of atopic eczema usually consists of moisturizing, using medication and avoiding triggers. Since the disease is considered chronic, the goal is symptom relief, rather than cure the disease.


General measures

In self-treatment, it is first and foremost important to avoid factors that you know trigger or aggravate the eczema. Because atopic eczema can have several underlying causes, it is not always possible to find all the triggers, but it is important to do the best you can.

This way you can relieve the ailments and prevent skin damage and further complications.

What you should do to reduce triggering environmental factors

The most important thing is to avoid itching on the eczema. If you scratch the eczema, the skin becomes more irritated and small sores and tears can occur. This increases the risk of bacterial infection. If you are very bothered, there are several different remedies that help with itching.

The indoor climate is also very important if you have atopic eczema. It should not be too dry air inside. Carpets and other objects that collect dust should be avoided, and it is strongly discouraged to have pets. It is also important that no one smokes in a home where someone has atopic eczema.

Since sweating and damp skin can aggravate eczema, it is advisable to keep the bedroom cool so that you sweat as little as possible at night. You should also avoid clothing that leads to extra sweating, such as very hot clothing or synthetic materials. Deep down, you should preferably wear cotton clothes.

When washing clothes, it is important that clothes, bed linen and towels are rinsed well after washing. This is because there are remnants of many detergents, and especially fabric softeners in the laundry after washing. Fabric softener should generally be avoided if you have atopic eczema and preferably you should also use perfume-free detergent.

Sun and light treatment can have a good effect on eczema and relieve ailments, but avoid getting sunburned.

For some, especially children, certain foods can aggravate eczema. If there is a suspicion of this, in consultation with a doctor, an attempt can be made to temporarily remove the food from the diet. It is very important that foods are not removed from children's diets unless there is a food allergy. This is due to children's need for a varied diet to grow and develop normally.

In cases where foods aggravate the rash, it is usually due to a hypersensitivity reaction, not a food allergy.

Moisture treatment

To treat atopic eczema, it is important to both keep the skin moist. Moisturizer helps rebuild skin barrier function and reduces the use of corticosteroids over time. Therefore, you should use moisturizer daily, and after each time you have taken a shower or a bath.

For best results, one should also avoid factors that make the skin drier. You should therefore try to shower and bathe less, and avoid using very hot water when you shower or bathe.

In areas with eczema rash, you should also avoid using soap, as soap dries out the skin. When using soap, make sure it has a pH of 5,5. Ideally, you should switch to a shower oil instead of using shower gel.

Because dry skin causes increased itching, moisture treatment is very important.

There is also literature showing that one can partially prevent atopic eczema from infancy by applying greasy cream daily. This is especially important in the winter, when it is dry and cold. In summer, you can use cream with a slightly lower fat percentage, but it is recommended to use a minimum of 20%.

Basic benefit and auxiliary benefit

Children under the age of 18 who have been diagnosed with atopic eczema after an examination in the specialist health service and have been prescribed preventive lubrication and escalation in the event of flare-ups can be granted assistance benefits if they apply for it.

The application must be sent in writing, and the form "Claim for assistance allowance" can be found on the NAV website.

If the eczema is very treatment-intensive and extensive, it is possible according to the National Insurance Act §6-3 to be granted basic benefit for extra expenses due to heavy wear and tear on clothes and bedding.

The application must be sent in writing and the form "Claim for basic benefit" can be found on the NAV website.

Contribution to coverage for over-the-counter products

According to the National Insurance Act §5-22, it is also possible to apply for a grant to cover expenses for non-prescription products. This applies if it is necessary to use over-the-counter ointments, creams and oils to treat significant and chronic skin disorders with dehydration of the skin.

A dermatologist or pediatrician submits an application to HELFO for this. If you are granted support, you must pay a fixed deductible per calendar year, and you have the option of being reimbursed 90% of the excess.

Medical treatment

In addition to moisture treatment, in many cases medical treatment of the eczema will be necessary. During treatment, it is important to continue to use plenty of moisturizer, as several of the drugs can dry out the skin somewhat.

To get the best treatment for your eczema, you should talk to your dermatologist. Some mild cortisone preparations, such as Hydrocortisone Evolan, sold without a prescription. However, you should always consult your dermatologist before starting treatment. This is also important with regard to follow-up during treatment. If you do not see the effect of the treatment you have been prescribed, it may be necessary to make adjustments.

Cortisone treatment

Atopic eczema can be treated in several different ways, but the most common is to use a cream or ointment that contains cortisone. If the skin is very dry, an ointment is preferably used.

The preparations are available in different strengths and are divided into 4 groups, and in many cases agents of different strengths are used during the same treatment.

Cortisone treatment is used because corticosteroids have an anti-inflammatory effect. At the same time, they relieve the pain, itching and discomfort the eczema has caused.

The strength of the cortisone treatment is determined by how old the patient is and where on the body the rash is located.

If the preparations are used correctly, there is little risk of side effects. With prolonged use, the skin may become somewhat thinner and more fragile, but in children and adolescents it has been observed that these changes return when the treatment is stopped.

To treat atopic eczema, you often start with a short course of cortisone preparations. The cure is usually 1-3 weeks long, where the eczema is lubricated once a day. Then follows a period of gradual tapering. If necessary, you can use repeated cures with a certain time interval between them.

Often such a short cure will have a good enough effect to get rid of eczema. Relapses can be prevented by performing maintenance treatment, especially in the form of moisture treatment. In the event of new outbreaks, it is important to start a new cortisone regimen quickly.

If the rash is very stubborn, it may be relevant with a longer cortisone treatment or the use of cortisone tablets for a short period.

Light treatment

Light therapy can be used to treat atopic eczema, and devices used in such treatment are divided into groups according to wavelength spectra:
• Broad spectrum UVB: 290-400 nm.
• Narrow spectrum UVB TL01: 311-313 nm, UVA1: 340-400 nm -possibly in combination with a tablet called psoralen (PUVA).
UVB are shortwave rays that best mimic natural sunlight, and UVB is used by most dermatologists - most often as narrow-spectrum UVB. UVB treatments are rarely used in the acute phase of atopic dermatitis. Treatments can initially be given three to five times per week and usually at least 20 treatments are performed.

Suppressive treatment

Immunosuppressive therapy, immunosuppressive therapy, is a form of immunomodulatory therapy.

Immunomodulatory therapy consists of the use of drugs that modify or alter the patient's immune system. Depending on what one wants to achieve, such drugs can either stimulate or suppress the immune system.

Immunosuppressive treatment is an alternative where local and / or light treatment does not give a good enough effect.

Regular blood tests must be performed if this type of treatment is used.

Biological drugs

The health authorities have relatively recently approved the use of biological medicines. These can have a good effect on moderate to severe itching. The medicines are expensive, but are approved for use in children aged 12 and up and for adults who have not had much effect from other treatment methods.

Other options

If bacterial infections occur in the eczema rash, your doctor may prescribe the use of antiseptics or antibiotics as a supplement to cortisone treatment.

Other treatments include potassium permanganate baths, crystal violet brushing and tar application. These treatments are not used as often as other treatment options.

If you experience very pronounced itching, this can be relieved by using itch-relieving medications, usually in the form of antihistamines.

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