Atopic Dermatitis

Definition

Definition of Atopic Dermatitis
Atopic dermatitis (a type of eczema) is an inflammatory, chronically relapsing, non-contagious and pruritic (that is, itchy) skin disorder. It has been given names like "prurigo Besnier," "neurodermitis," "endogenous eczema," "flexural eczema," "infantile eczema," and "prurigo diathésique".

Symptoms

Symptoms of Atopic Dermatitis
The skin of a patient with atopic dermatitis reacts abnormally and easily to irritants, food, and environmental allergens and becomes red, flaky and very itchy. It also becomes vulnerable to surface infections caused by bacteria. The skin on the flexural surfaces of the joints (for example inner sides of elbows and knees) are the most commonly affected regions in people.

1. Atopic dermatitis often occurs together with other atopic diseases like hay fever, asthma and allergic conjunctivitis. It is a familial and chronic disease and its symptoms can increase or disappear over time. Atopic dermatitis in older children and adults is often confused with psoriasis. Atopic dermatitis afflicts humans, particularly young children; it is also a well-characterized disease in domestic dogs. Although there is no cure for atopic eczema, and its cause is not well understood, it can be treated very effectively in the short term through a combination of prevention (learning what triggers the allergic reactions) and drug therapy.
2. Atopic dermatitis most often begins in childhood before age 5 and may persist into adulthood. For some, it flares periodically and then subsides for a time, even up to several years. Yet, it is estimated that 75% of the cases of atopic dermatitis improve by the time children reach adolescence, whereas 25% continue to have difficulties with the condition through adulthood. Although atopic dermatitis can theoretically affect any part of the body, it tends to be more frequent on the hands and feet, on the ankles, wrists, face, neck and upper chest. Atopic dermatitis can also affect the skin around the eyes, including the eyelids.

In most patients, the usual symptoms that occur with this type of dermatitis are aggravated by a Staphylococcus aureus infection, dry skin, stress, low humidity and sweating, dust or sand or cigarette smoke. Also, the condition can be worsened by having long and hot baths or showers, solvents, cleaners or detergents and wool fabrics or clothing.

Causes

Causes of Atopic Dermatitis
Atopic dermatitis is due to a hypersensitivity reaction (similar to an allergy) in the skin, which leads to long-term swelling and redness (inflammation) of the skin. People with atopic dermititis may lack certain proteins in the skin, which leads to greater sensitivity.

Atopic dermatitis is most common in infants. It may start as early as age 2 to 6 months. Many people outgrow it by early adulthood.

People with atopic dermatitis often have asthma or seasonal allergies. There is often a family history of allergic conditions such as asthma, hay fever, or eczema. People with atopic dermatitis often test positive to allergy skin tests.

Diagnosis

Diagnosis of Atopic Dermatitis
A physical exam will be done. A skin biopsy can be done to confirm the diagnosis or rule out other causes of dry, itchy skin.

Diagnosis is based on the:

1. Appearance of the skin
2. Personal and family history

Allergy skin testing may be helpful for people with:

1. Hard-to-treat atopic dermatitis
2. Other allergy symptoms
3. Skin rashes that form only on certain areas of the body after exposure to a specific chemical

Treatment

Treatment of Atopic Dermatitis
Taking care of your skin at home may reduce the need for medications.

Avoid scratching the rash or skin:

1. Relieve the itch by using a moisturizer, topical steroid cream, or other prescribed cream and taking antihistamines to reduce severe itching.
2. Keep your child's fingernails cut short. Consider light gloves if nighttime scratching is a problem.
3. Keep the skin moist (called lubricating or moisturizing the skin). Use ointments (such as petroleum jelly), creams, or lotions 2 - 3 times a day. Moisturizers should be free of alcohol, scents, dyes, fragrances, or other chemicals. A humidifier in the home will also help.

Avoid anything that makes your symptoms worse. This may include:

1. Foods such as eggs in a very young child (always discuss with your doctor first)
2. Irritants such as wool and lanolin
3. Strong soaps or detergents, as well as chemicals and solvents
4. Sudden changes in body temperature and stress, which may cause sweating and worsen the condition. Triggers that cause allergy symptoms

When washing or bathing:

1. Keep water contact as brief as possible and use gentle body washes and cleansers instead of regular soaps. Short, cooler baths are better then long, hot baths.
2. Do not scrub or dry the skin too hard or for too long.
3. After bathing, it is important to apply lubricating creams, lotions, or ointment on the skin while it is damp. This will help trap moisture in the skin.

Prognosis

Prognosis of Atopic Dermatitis
Atopic dermatitis is a long-term condition, but you can control it with treatment, by avoiding irritants, and by keeping the skin well-moisturized.

In children, the condition often clears beginning at around age 5 - 6, but flare-ups will often occur. In adults, it is generally a long-term or returning condition.

Prevention

Prevention of Atopic Dermatitis
Studies have shown that children who are breast-fed until age 4 months are less likely to get atopic dermatitis.

If the child is not breast-fed, using a formula that contains processed cow milk protein (called partially hydrolyzed formula) may decrease the chances of developing atopic dermatitis.