Atopic Dermatitis - a Chronic Relapsing Skin Disease

What Is Atopic Dermatitis?

Atopic dermatitis is endogenous eczema (eczema due to internal causes) characterized by extreme itchiness and recurrent symmetric eczematous dermatitis. 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 particular food may aggravate this disease in a specific subset of patients. The involvement of a site depends on the age of the patients. Its clinical course and features vary with age and are easily aggravated by secondary infections. Herpes simplex virus infection can cause a severe rash called Kaposi varicelliform eruption in children with atopic eczema.

What Causes Atopic Dermatitis?

Genetic variation in the skin, which results in the inability of the skin to retain moisture, results in atopic dermatitis. Moisture is essential for the skin to protect against irritants, allergens, and other environmental factors.

What Are the Clinical Features of Atopic Dermatitis?

Symptoms of atopic dermatitis include the following:

• Itching that may be intense at night.

• Tiny, elevated bumps on the skin that cracks open and releases fluids upon scratching.

• Skin dryness.

• Patches range from red to brownish-gray in color and are commonly seen on the upper chest, ankles, feet, arms, eyelids, wrists, neck, elbows, face, scalp, etc.

• Scratching results in thin, raw, sensitive, and swollen skin.

• Skin becomes thick, scaly, and has a cracked appearance.

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

• Atopic dermatitis in infancy.

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• Childhood phase.

• 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; they look like tree bark. It involves the cubital (front of the elbow), popliteal fosse (back of the knee), and sometimes the neck. A low-grade involvement may be seen in the rest of the body. Discoid patterns (coin-shaped) of eczema may be seen.

What Increases the Risk Of Developing Atopic Dermatitis?

Family history or personal history of Hay fever, eczema, asthma, or allergy.

How is Atopic Dermatitis Diagnosed?

Visual examination is done to diagnose atopic dermatitis, which is accompanied by medical history. If needed, patch skin tests can be taken to rule out other skin conditions. Also, it is essential to look for potential allergens.

What Is the Treatment of Atopic Dermatitis?

General Measures:

• Avoid triggering factors that provoke itching.

• 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 mites using barriers on mattresses and quilts, thorough and regular vacuuming of rooms, avoiding the use of carpets, and use of anti-mite sprays.

Topical Therapy:

Moisturizers- Emollients are used to alleviate the itching due to dry skin. Emollients can be added to the bath or applied directly to the skin.

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 eczema substantially.

Antihistamines:

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 integral part of the treatment. Counseling 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 age. They should avoid occupations such as car mechanics, engineering, hairdressing, or nursing.

What are the Complications Of Atopic Dermatitis?

1. Asthma and Hay Fever: Atopic dermatitis is often followed by allergy and hay fever and is seen in more than 50% of children above the age of 13.

2. Skin Infections: Repetitive scratching causes the pores to open and gives a cracked appearance, increasing the chance of bacterial and viral infection, particularly herpes simplex infection.

3. Problems With Sleep: Disturbances in the sleep pattern are seen with the presence of the itch-scratch cycle.

4. Neurodermatitis: Itching is associated with neurodermatitis, which gradually increases the intensity of itching resulting in thick, scaly, leathery, and discolored skin.

5. People exposed to soaps, irritants, and detergents and those who work in damp areas develop irritant contact dermatitis.

6. Allergic Contact Dermatitis.

How Can We Prevent Atopic Dermatitis?

• Identifying the triggering factors and avoiding them.

• Using a moisturizer for your skin at least twice daily.

• Gently pat dry the skin after bathing with a soft towel and applying moisturizer while still moist.

• Avoiding bactericidal and deodorant soaps, which reduce the moisture content of the skin, and using only mild soaps.

• Taking a bleach bath.

• Showering for only 5 to 10 minutes with warm water instead of using hot water for bathing.

Conclusion:

Atopic dermatitis is not a contagious condition, and people with these skin conditions should not be treated with shame. In addition to medical treatment, psychological therapy is needed to help them lead happy and peaceful lives.