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Atopic Dermatitis

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Overview of atopic dermatitis

Atopic dermatitis is a long-term (chronic) inflammatory state of the skin, which is characterized by an itching sensation (pruritus) in the affected areas (cheek and buttock region are more commonly affected). This disorder is considered as the most common skin disorder in children of the developed countries wherein 15–20% of children are affected. Atopic dermatitis affects about 1–3% of the adults wherein it may either be the persistent version or may have developed newly. Interestingly, the incidence is lower in countries, which have higher concentration of rural and agricultural areas. Several investigators suggest that atopic dermatitis is one of the symptoms of an underlying disorder, which is also responsible for other conditions such as asthma, food allergy and allergic rhinitis.1,2

Signs and Symptoms of atopic dermatitis

Atopic dermatitis is most commonly characterized by pruritus. The affected areas of skin are inflamed, red and itchy. The pruritus may at times be severe enough to cause sleep disturbances, irritability and generalized stress. The continuous scratching of the skin can cause secondary changes in the skin such as thickening of the skin, formation of scaly skin and breakdown in the continuity of skin, which may give way for infection. In infants and young children, the rashes occur mainly on the face and scalp while in case of teenagers and young adults, the patches typically occur on the hands and feet. However, any area such as the bends of elbows, backs of the knees, ankles, wrists, face, neck and upper chest region may be affected. It has been also noted that about 50–80% individuals who suffer from atopic dermatitis are either sufferers of concomitant asthma or allergic rhinitis or may develop these disorders at a later stage in life.4

The factors that may trigger an itch reaction in the individuals suffering from atopic dermatitis include soaps, detergents, disinfectants, contact with juices from fresh fruits or vegetables, dust mites, hair of pets, pollen and dandruff. 3

Causes of atopic dermatitis

Several studies have indicated a number of complex processes by which atopic dermatitis develops. These processes result in activation of numerous pathways of inflammatory reactions in the body which gives rise to the skin manifestations. Numerous factors such as the genetic structure of the affected individual, the environment he/she lives in, defects in the functioning of the skin cells and tissues, and response of the body to the irritating agents such as dust have been suggested as the causative factors.

Children whose parents suffered from atopy or eczema are more prone to develop this disorder. The risk is considered greater in children whose mother suffered from atopy.2,3

Diagnosis of atopic dermatitis

The diagnosis of atopic dermatitis is based on a comprehensive review of the history of the condition and signs and symptoms noted. The doctor performs physical examination to record the affected areas and evaluate the severity of the condition. Occasionally certain blood tests may be advised to rule out the presence of any other disorders.

Treatment of atopic dermatitis

Atopic dermatitis is a chronic condition, which requires regular therapy for quite a long period of time. It involves simple home measures to reduce the itch, administration of certain medications and certain specialized treatment such as phototherapy.

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The home care measures that are advised include:

  • Using gentle cleansing solutions to clean the affected areas (avoid scrubbing and repeated cleaning).
  • Cosmetic substances should not be applied on the affected areas.
  • Hot water tends to increase the skin irritation and hence normal or warm water should be used to clean the affected area.
  • Do not rub the affected areas after cleaning, instead pat dry the skin with soft towel
  • Certain medicated lotions that contain calamine may be helpful

The medications that are advised for the treatment of pruritus, infections and other features associated with atopy belong to the group of antibiotics, corticosteroids, antihistamines, antidepressants, antiinflammatory medications and immunosuppressants. Some of these medications are available as ointments and may be advised to apply over the affected areas. Phototherapy wherein the affected regions are exposed to ultraviolet rays has also proven beneficial.4,5

Complications of atopic dermatitis

The chronic dermatitis may be associated with complications such as infection of the affected areas and permanent scarring. Individuals who suffer from atopic dermatitis during their childhood are at a higher risk to develop asthma and allergic rhinitis when compared to others.

Prevention of atopic dermatitis

Although the occurrence of atopic dermatitis cannot be prevented, the flare up of its commonest feature, pruritus can be effectively prevented. Avoidance of any particular product or other substances that are associated with allergy is beneficial. Repeated bathing in a single day can make the skin dry and hence should be avoided. Use of mild soaps that do not leave the skin excessively dry after bathing should be used. Moisturizing lotions may be applied if the skin tends to be dry after washing or bathing.

References

1.Leung DYM, Boguniewicz M, Howell MD, Nomura I, Hamid QA. New insights into atopic dermatitis. J Clin Invest. 2004; 113(5): 651–657.

2.Brown S, Reynolds NJ. Atopic and non-atopic eczema. BMJ. 2006; 332: 584–588.

3.Beltrani VS, Boguneiwicz M. Atopic dermatitis. Dermatology Online Journal. 2003; 9(2): 1.

4.Correale CE, Walker C, Murphy L, Craig TJ. Atopic dermatitis: A review of diagnosis and treatment. Am Fam Physician. 1999; 60: 1191–210.

5.Buys LM. Treatment options for atopic dermatitis. Am Fam Physician. 2007; 75: 523–528, 530.

Written by: healthplus24.com team

Date last updated: March 12, 2015