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Study author highlights test used to differentiate between two types of eczema
ROSEMONT, Ill. (September 26, 2023) — Eczema, which is a group of medical conditions that causes inflamed, irritated, and often itchy skin, affects millions of people worldwide. A new article published in the Journal of the American Academy of Dermatology reveals that children diagnosed with a type of eczema called atopic dermatitis — which they usually develop by 5 years of age — may also need to be tested for a second type of eczema called allergic contact dermatitis, which has similar symptoms and can be triggered by a range of substances that cause an allergic reaction.
“When a dermatologist sees a child who looks like they have eczema, we usually think that it’s atopic dermatitis because nearly one in five children develop it,” said board-certified dermatologist JiaDe (Jeff) Yu, MD, MS, FAAD, assistant professor of adult and pediatric dermatology at Massachusetts General Hospital and senior author of the study. “Sometimes these kids could have allergic contact dermatitis, but the only way to tell is through patch testing, which is designed to identify substances that may be irritating your skin.”
Liz Schoeben first developed atopic dermatitis when she was nine.
“I remember having it in elementary school off and on,” said the Los Angelian mother of three. “Years later when I was 47, it became much more severe and spread to my legs and eventually to my face.”
It wasn’t until Schoeben made an appointment to see board-certified dermatologist Jenny Murase, MD, FAAD, an associate clinical professor of dermatology at the University of California San Francisco, that she learned through patch testing that in addition to having atopic dermatitis she was allergic to six different substances, including several that are commonly found in skin care products, that were causing allergic contact dermatitis. The allergies developed over time after repeated exposure to the substances, and Schoeben became increasingly sensitive to them.
“It turns out that most of the things that I’m allergic to are very common ingredients in a lot of products,” Schoeben said. “I’m allergic to a type of formaldehyde that’s in a lot of skin care products and shampoos. I’m also allergic to beeswax. It was frustrating because I had been using these products for years without realizing they were the cause of my allergic reactions.”
Poison ivy, poison oak, and poison sumac are the most common causes of allergic reactions in the United States. Other common causes of allergic contact dermatitis include metals (such as nickel), rubber, dyes, cosmetics, preservatives, and fragrances.
Treatment options for atopic dermatitis include steroids that can be applied to the skin, phototherapy, which uses ultraviolet light to reduce inflammation and ease itch, medications called “biologics” that work throughout the body, and medications that are used to suppress the immune system, such as JAK inhibitors, Dr. Yu said. While these options also can be used to treat allergic contact dermatitis, identifying and avoiding substances that are causing the allergic reactions is most effective in helping improve a patient’s condition and to clear their skin.
Lifestyle changes can also relieve eczema symptoms, he said.
It’s important to choose fragrance-free products because fragrances can contribute to flare-ups, he noted. People with eczema should test new skin care products first by applying them to a quarter-sized patch of skin on the inside of the arm every day for four weeks. If there is no reaction, the patient will likely be able to use the product.
Dr. Yu emphasized the need for people who show signs of having eczema to consult a board-certified dermatologist, who can determine whether a patient has atopic dermatitis, allergic contact dermatitis, or both.
“Patients can have atopic dermatitis and allergic contact dermatitis at the same time, and it all looks like the same thing,” he said. “I imagine it like layers of a cake. Maybe the first layer is atopic dermatitis, and then the second layer is allergic contact dermatitis. In these cases, the overall eczema may look very severe but once you remove the allergic component, the eczema seems much more manageable. A board-certified dermatologist can provide you with an accurate diagnosis by performing a patch test to determine whether you have allergic contact dermatitis and determine how to appropriately treat it.”
To find a board-certified dermatologist in your area, visit aad.org/findaderm.
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Headquartered in Rosemont, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential and most representative of all dermatologic associations. With a membership of more than 20,800 physicians worldwide, the AAD is committed to advancing the diagnosis and medical, surgical, and cosmetic treatment of the skin, hair, and nails; advocating high standards in clinical practice, education and research in dermatology; and supporting and enhancing patient care because skin, hair, and nail conditions can have a serious impact on your health and well-being. For more information, contact the AAD at (888) 462-DERM (3376) or aad.org. Follow @AADskin on Facebook, Pinterest and YouTube and @AADskin1 on Instagram.
Editor’s note: The AAD does not promote or endorse any products or services. This content is intended as editorial content and should not be embedded with any paid, sponsored or advertorial content as it could be perceived as an AAD endorsement.