Atopic dermatitis

Atopic dermatitis, also called eczema, is the most common inflammatory skin condition found in infants and children, and manifests as areas of erythematous (red), dry, and cracked skin, with intensive itching. It occurs most often during childhood, up to the age of 5 – estimating that up to 20% of children have a form of atopic dermatitis. However, most people outgrow it by the time they are teenagers, and it rarely persists into adulthood.

Eczema appears to be caused by an interplay of genetic and environmental factors and it is noted people suffering from that disease usually develop also certain allergic conditions, asthma, rhinitis, conjunctivitis, food intolerances. In essence, atopic dermatitis represents the skin’s inability to maintain an optimal level of hydration, thus compromising its role as the first line of defense against environmental insults.

The symptoms of atopic dermatitis vary from person to person and depend on age, but as a rule, all of the patients experience intense itching that causes scratching and skin lesion. Affected areas in children are usually skin folds of arms and legs, as well as face and scalp; the most common manifestations are redness, blisters (fluid bumps), dry, scaly, thickened, and cracked skin, followed by infections due to scratching.

Atopic dermatitis is considered a chronic disease that – if not overgrown – lasts a lifetime, going through alternating periods of remission and flare-ups, triggered by various environmental factors, infections, irritating agents, or allergens. People with atopic dermatitis should be aware of these and avoid the following ones as much as possible:

  • environmental allergens: dust, pollen, dust mites, animal hair
  • food allergens: milk, eggs, peanuts
  • cleaning products that dry the skin
  • low temperatures
  • clothing made of irritating materials (wool, polyester, acrylic)
  • infectious agents
  • emotional stress

The diagnosis of atopic dermatitis is a clinical one, in other words, the dermatologist or pediatrician can diagnose so based on the manifestations and the patient’s history, with no need for other tests. When it comes to children diagnosed with eczema, it is usually examined if at least one of the parents has been going through that same condition in their childhood. On the other hand, should the eczema be identified in adulthood, a different type of the disease, specific to adults, is seen in place. Sometimes, if a link to food intolerances or other allergies is suspected, certain allergy tests can be performed to identify the factors with the highest potential for triggering or aggravating the disease.

The treatment of atopic dermatitis flare-up is carried out by a health professional such as a physician, and it can include corticosteroid creams, antihistamines, calcineurin inhibitors – their role is to reduce inflammation, relieve the itching, and help to restore the skin barrier. The cases which have been further complicated by infections require antibiotic treatment. Severe forms of eczema are treated with peroral administration drugs or even biological therapies with monoclonal antibodies.

Atopic dermatitis patients should observe a series of general hygiene and skincare rules:

  • Excessive skin washing and hot water, and irritating cleansers are to be avoided. Antibacterial soaps, aggressive shower gels remove from the skin’s surface the precious natural oils which are anyway already deficient in atopic dermatitis. Shower oils or cleansing creams that protect the lipid layer of the skin are recommended.
  • After the bath, the skin should be dried by gentle patting and not by rubbing with a towel. Moisturizers are to be applied while the skin is still damp.
  • Emollient creams are the most important element in atopic dermatitis treatment – both in remission and flare-ups. These are to be applied twice a day and most important – immediately after each washing of the skin. Products should be free of perfumes and dyes, low in water content, and rich in ceramides.
  • Wet compresses help soothe the atopic skin during flare-ups.
  • It is recommended that clothes and textiles that come in direct contact with the skin are to be made of cotton. Wool and synthetic textiles irritate the skin. The detergents used for washing clothes must be gentle, unscented, suitable for sensitive skin.
  • Extreme temperature can trigger atopic dermatitis too. In living spaces, both the temperature and humidity must be maintained constant.
  • Natural treatments and old-fashioned, or homemade remedies are to be avoided as most of these show very high irritating and allergenic potential. Also, mixtures containing menthol do not help relieve the itching but only aggravate eczema by further drying the skin.
  • Stress and anxiety increase the frequency of flare-ups therefore a balanced lifestyle is important for keeping eczema in remission.

dr. Alexandra Batani
Dr. Alexandra Bațani,
Dermatologist
DermaExpert Clinic, Bucharest

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