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Atopic Dermatitis. Causes, Symptoms and Treatment


Eczema is a group of skin conditions that result in itchy, red, inflamed skin. It affects millions of people worldwide. Although eczema is not contagious or usually life-threatening, it can be challenging to treat and cause significant sickness. The most common form of it is atopic dermatitis.

What are the different types of eczema?

There are seven different types of eczema, but atopic dermatitis is the most common.

  1. Atopic dermatitis
  2. Contact dermatitis
  3. Dyshidrotic dermatitis
  4. Hand dermatitis
  5. Neurodermatitis
  6. Nummular dermatitis
  7. Stasis dermatitis

Atopic dermatitis is a complex disease that involves the interplay between your genetics, your immune system, and your environment. There is a defect in the genes that control the skin’s barrier, and this defect often runs in families.

The job of the skin’s barrier is to keep moisture in and germs out. If the skin’s barrier does not function optimally, the skin becomes dry, dehydrated, irritated, and susceptible to infections.

Even if your skin has a dysfunctional barrier, you may not develop atopic dermatitis if your environment is optimal. Here are some environmental triggers to avoid.

  • Cold or dry places tend to trigger atopic dermatitis flares.
  • Stress and exposure to excess pollution in big cities make atopic dermatitis worse.
  • Smoking can also worsen atopic dermatitis.

Who gets atopic dermatitis?

Atopic dermatitis affects about 10% of the population. It can be present in any age group, however, it is more prevalent in children, affecting about 25%. Most children develop it by age five and grow out of it by age 12. Unfortunately, it is a lifelong condition for some.

Atopic dermatitis can affect any ethnic group, but those of African or Asian descent are more susceptible to developing it. It is often more challenging to diagnose this in darker-skinned people, often leading to delayed treatment.

Atopic dermatitis frequently runs in families and accompanies other conditions such as allergic rhinitis – when your nose is irritated by something you’re allergic to – and asthma. One or all of these three conditions can run in families.

What are the signs and symptoms of atopic dermatitis?

Atopic dermatitis is often referred to as the “itch that rashes” because the presenting symptom is usually itchiness. The more a person is itchy, a rash will develop. Some of the symptoms include:

  • Itchiness.
  • Red, scaly patches on the skin.
  • Oozing erosions that bleed and scab.
  • Red, swollen, tender areas that may ooze pus (due to an infection).
  • Thickened brown patches on the skin from repeated, long-term scratching (lichenification).
  • Discoloration from scars that result from scratching.
  • Many deep lines in the palms of the hands (hyperlinear palms).

Atopic dermatitis may affect different areas of the body depending on age.

  • Babies often get it on their scalp and face, especially their cheeks.
  • Children have it in the creases of their elbows, knees, wrists, and ankles.
  • Adults present with it on their hands and around their eyes.

These are not hard and fast rules because atopic dermatitis can appear anywhere at any time on the body.

How is atopic dermatitis diagnosed?

The best way to diagnose and treat your atopic dermatitis is to go to your dermatologist. Your dermatologist will ask you questions about you and your family. Sometimes, a skin biopsy is necessary to diagnose and treat your condition.

Many different rashes can mimic atopic dermatitis, so it is vital to obtain the correct diagnosis and treat accordingly, without any delay. The longer you delay, the higher your chance of infection and scarring.

Why do you treat atopic dermatitis?

There are several reasons to treat atopic dermatitis.

  • Ease the symptoms of itchiness or discomfort.
  • Stop the signs of rash (redness, scaling, oozing, bleeding, and crusting).
  • Prevent future flares.
  • Prevent atopic dermatitis from worsening and leading to scars, dyspigmentation, and thickened skin.
  • Prevent infection and hospitalization.
  • Keep your skin healthy with good hygiene.
  • Avoid triggers

Basic skin hygiene is necessary for everyone but critical for those with atopic dermatitis. This includes the following:

Cleansing - You must clean your skin daily to remove dirt and bacteria.

  • Use a dye and fragrance-free creamy body and face wash. Dyes and fragrances can irritate the skin and trigger a flare-up.
  • Avoid bar soap because it is too harsh and alkaline, which destroys the skin’s protective barrier.
  • Limit showers to 10 minutes and use lukewarm water, not hot water.
  • Pat your skin dry with a clean towel. Do not rub your skin.

Moisturizing - You must apply a moisturizer several times a day, especially after bathing. Atopic dermatitis patients have a dysfunctional skin barrier and lose excess moisture. Using the proper moisturizer will add the necessary moisture to your skin and lock it in.

  • As with all products, use a dye and fragrance-free moisturizer.
  • Select one that is thick and creamy or an ointment base.
  • If you are prone to acne, select one that is oil-free and will not block pores.

Your dermatologist will have medications to help ease the signs and symptoms of atopic dermatitis. These may include:

  • Steroids - Steroid creams and pills (in severe cases) will decrease the inflammation in your skin to ease the itchiness and help resolve the rash.
  • Topical immunomodulators - These include calcineurin inhibitors (Elidel cream and Protopic ointment) and phosphodiesterase inhibitors (Eucrisa). They work like a steroid to decrease inflammation in the skin but without the long-term side effects of steroids.
  • Antihistamines - Antihistamines will help ease the itching sensation.
  • Phototherapy - This is a treatment done in your doctor’s office to help reduce the itchiness.
  • Systemic medications - These include immunosuppressants (azathioprine, cyclosporin, methotrexate, and mycophenolate mofetil) and immunomodulators (dupilumab). Because they can have serious side effects, they are reserved for the most severe cases.

Here are some lifestyle changes that can help reduce your flares.

  • Always do a test spot for any products you use on our skin.
  • All products (soap, moisturizer, sunscreen, and makeup) that come in contact with your skin need to be dye and fragrance-free. This includes laundry detergents. Avoid fabric softener and bleach. Avoid perf
  • Wear loose-fitting clothing. Tight-fitting clothing can irritate the skin.ume and cologne.
  • Use only cotton clothing, sheets, and towels. Synthetics and wool can irritate the skin.
  • Avoid triggers.
  • Use a humidifier if you live in a dry climate.
  • Avoid temperature extremes.
  • Lower your stress.
  • Avoid getting sick.

Key take-aways

Eczema is a term that refers to a group of skin conditions, and atopic dermatitis is the most common.

Atopic dermatitis affects about 10% of the population.

People experience itchiness and rashes that, left untreated, can lead to infections and scarring.

Proper hygiene, medications, and lifestyle modifications can help keep atopic dermatitis under control and keep you symptom-free.

If you cannot get atopic dermatitis under control or have an infection, please seek help from a board-certified dermatologist.

References

Atopic dermatitis. www.aad.org

Bolognia, J., Jorizzo JL., Schaffer, JV. (2012). Dermatology. Philadelphia: Elsevier Saunders.

Eichenfield LF., Tom WL., Chamlin SL., Feldman SR., Hanifin JM., Simpson EL., Berger TG., Bergman JN., Cohen DE., Cooper KD., Cordoro KM., Davis DM., Krol A., Margolis DJ., Paller AS., Schwarzenberger K., Silverman RA., Williams HC., Elmets CA., Block J., Harrod CG., Smith Begolka W., Sidbury R. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. Journal of the American Academy of Dermatology. 2014 Feb;70(2):338-51.

Sidbury R., Tom WL., Bergman JN., Cooper KD., Silverman RA., Berger TG., Chamlin SL., Cohen DE., Cordoro KM., Davis DM., Feldman SR., Hanifin JM., Krol A., Margolis DJ., Paller AS., Schwarzenberger K., Simpson EL., Williams HC., Elmets CA., Block J., Harrod CG., Smith Begolka W., Eichenfield LF. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. Journal of the American Academy of Dermatology. 2014 Dec;71(6):1218-33.

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