Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Atopic dermatitis affects each child differently, both in terms of onset and severity
of symptoms. In infants, atopic dermatitis typically begins around 6 to 12 weeks
of age. It may first appear around the cheeks and chin as a patchy facial rash, which can
progress to red, scaling, oozing skin. The skin may become infected. Once
the infant becomes more mobile and begins crawling, exposed areas such as
the knees and elbows may also be affected. An infant with atopic dermatitis
may be restless and irritable because of the itching and
discomfort. Many infants improve by 18 months of age, although they
remain at greater than normal risk for dry skin or hand eczema later in life.
In childhood, the rash tends to occur behind the knees and inside the elbows, on the sides of
the neck, and on the wrists, ankles, and hands. Often, the rash begins with papules
that become hard and scaly when scratched. The skin around the lips may be
inflamed, and constant licking of the area may lead to small, painful
cracks. Severe cases of atopic dermatitis may affect growth, and the child may be shorter than average.
The disease may go into remission (disease-free period). The length of a remission varies, and it may last months
or even years. In some children, the disease gets better for a long time only to come
back at the onset of puberty when hormones, stress, and the use of
irritating skin-care products or cosmetics may cause the condition to
flare.
Although a number of people who developed atopic dermatitis as children also experience symptoms as
adults, it is less common (but possible) for the disease to show up first in
adulthood. The pattern in adults is similar to that seen in children; that is,
the disease may be widespread or limited. In some adults, only the hands or feet may be affected and become dry,
itchy, red, and cracked. Sleep patterns and work performance may be
affected, and long-term use of medications to treat the condition may cause
complications. Adults with atopic dermatitis also have a predisposition
toward irritant contact dermatitis, especially if they are in occupations
involving frequent hand wetting, hand washing, or exposure to chemicals.
Some people develop a rash around their nipples. These localized symptoms
are difficult to treat, and people often do not tell their doctor because
of modesty or embarrassment. Adults may also develop cataracts that are
difficult to detect because they cause no symptoms. Therefore, the doctor
may recommend regular eye exams.
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Keratosis pilaris (KP) is a common skin disorder in which small white or red bumps appear around hair follicles on the upper arms, thighs, buttocks, and cheeks. The cause of KP is unknown. There is no cure for keratosis pilaris, and the condition may resolve on its own. Gentle exfoliation, professional manual extraction, chemical peels, and microdermabrasion, along with topical products, are the best treatments for this condition.
Swimmer's ear (external otitis) is an infection of the skin that covers the outer ear canal. Causes of swimmer's ear include excessive water exposure that leads to trapped bacteria in the ear canal. Symptoms include a feeling of fullness in the ear, itching, and ear pain. Chronic swimmer's ear may be caused by eczema, seborrhea, fungus, chronic irritation, and other conditions. Common treatment includes antibiotic ear drops.
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