Dermatologists and Skin Care

Atopic Dermatitis - a Chronic Relapsing Skin Disease

Written by Dr. Suvash Sahu and medically reviewed by iCliniq medical review team.

 
Image: Atopic Dermatitis - a Chronic Relapsing Skin Disease

Contents


Atopic dermatitis is an endogenous eczema (eczema due to internal causes) characterized by extreme itchiness and recurrent symmetric eczematous dermatitis. The involvement of a site depends on the age of the patients. This chronic eczema is one of the atopic conditions and together with asthma and hay fever, it has a heritable tendency. Certain environmental factors like winter, inhaled allergens and certain food may aggravate this disease in a certain subset of patients. Its clinical course and features vary with age and are easily aggravated by secondary infections. Herpes simplex viral infection can cause a very severe rash called as Kaposi varicelliform eruption in children with atopic eczema.

Clinical Features

Three distinct patterns of atopic dermatitis have been recognized depending on the patient's age:

  1. Atopic dermatitis in infancy.
  2. Childhood phase.
  3. Adult phase.

Atopic Dermatitis in Infancy (Infantile Eczema)

Atopic dermatitis in babies begins after the age of 3 months. Lesions are intensively itchy papules and vesicles, which soon discharge serous fluids. Lesions begin on the face, but can involve the rest of the body. But, usually, there is sparing of the diaper area and secondary infection is common.

Childhood Phase

Dry, leathery and extremely itchy, raised areas (plaques), mainly on the elbow and knee flexors. Sometimes, a reversed (extensor) pattern may be seen.

Adult Phase

Lesions are very itchy and lichenified, looks like tree bark. It involves the cubital (front of the elbow) and popliteal fosse (back of knee) and sometimes the neck. A low grade involvement may be seen on the rest of the body. Discoid pattern (coin shaped) of eczema may be seen.

Treatment

General Measures:

  • Avoid irritants, which may trigger itching, like woolen clothes, chemicals, etc.
  • Avoid excessive cleaning or degreasing of the skin and use mild soaps or cleaning lotions.
  • Avoidance measures include reduced contact with house dust mite using barriers on mattresses and quilt, thorough and regular vacuuming of rooms, avoiding use of carpets and use of anti-mite sprays.

Topical Therapy:

  1. Moisturizers - Emollients are used to alleviate itching due to dry skin. Emollients can be added to the bath or applied directly to the skin.
  2. Topical steroids - These are used for localized exudative lesions and sometimes in combination with topical or systemic antibiotics to prevent secondary infections if any. Topical macrolactam immunomodulators like Tacrolimus and Pimecrolimus are the latest topical agents for atopic dermatitis.

Systemic Therapy:

Systemic antibiotics are used in patients with extensive infected lesions. Systemic steroids with the availability of potent topical steroids and systemic corticosteroids have reduced the eczema substantially.

Antihistamines:

Especially, the sedating ones are used regularly to overcome the itching and are of great value in whom sleep is interrupted.

Counseling and Psychotherapy:

Not only can stress aggravate atopic dermatitis, but the severely affected child is also a source of stress for the whole family. Counseling is an important part of the treatment. Counseling of parents for do’s and don’ts when the patient is a child will help them lead a stress-free life. Adolescents with atopic dermatitis should be well advised that this disease often improves or goes into remission with ages. They should avoid occupations such as car mechanics, engineering, hairdressing or nursing.

For further information regarding atopic dermatitis consult an atopic dermatitis specialist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist/atopic-dermatitis

Last reviewed at: 07.Sep.2018

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