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ATOPIC DERMATITISATOPIC DERMATITIS – General InformationAtopy means hypersensitivity to substances especially to allergens in the environment. Dermatitis means inflammation of the skin. Atopic dermatitis is a chronic skin disease. It is also known as atopic eczema. Its main characteristic is chronic inflammation of the skin. The skin becomes extremely itchy, inflamed causing redness, swelling, cracking, weeping, crusting, and scaling. It is an abnormal reaction to irritants, food, and environmental allergens and seen to occur along with hay fever, asthma, and conjunctivitis. It is often confused with another skin condition called psoriasis. It cannot spread from one person to another, meaning it is noncontiguous. It is seen commonly in babies and children but can continue into adulthood. It can also have its first onset in adulthood. Permanent remission is seen in many children as they grow up but their skin often ends up remaining dry and easily irritated. The exact cause of the disease is not clear though it is most commonly seen in people with very sensitive immune systems. It is also seen in people who have a family history of allergies such as hay fever and asthma. Environmental factors can bring about the symptoms in people who have inherited this disease trait. The skin inflammation that causes the rash is thought to be a type of allergic response. Exacerbating factors for atopic dermatitis include: Stress, certain foods such as eggs, peanuts, milk, wheat, or soy products, allergens such as dust mites or animal dander, harsh soaps, weather changes (dry and cold), or skin infection.ATOPIC DERMATITIS – SymptomsItching is the first sign of atopic dermatitis and rash is seen soon after. The rash may be chronic or intermittent and it is red and patchy. The blisters may be formed and they ooze fluid and crust over. Infection starts to occur with scratching. The more you scratch, the more infected the rash becomes and with recurrence over time, thickened skin starts to appear. Itchiness may be worse at night and can interfere with sleep. Moisturizing usually helps mild atopic dermatitis which is seen in small areas of skin but when large area of skin is affected, it is severe and symptoms are not alleviated with moisturizing. Severe rashes can spread all over the body. Face, neck, arms, and legs are some of the common areas of this kind of a rash. Rashes in the groin are also seen to appear but they are rare. The sites of these rashes vary from person to person depending on their age. Infantile eczema occurs mainly in the face and scalp and is usually red with itching, oozing, and crusting over. In adults, it is seen in the face, neck, and upper trunk areas and what starts out as a red itchy rash goes on to leathery and dry skin with scratching over time. People afflicted with this kind of a rash are more prone to get other skin infections as the skin is usually open and raw from repeated scratching. These infections (bacteria, fungi, viruses) make dermatitis more difficult to control.ATOPIC DERMATITIS – TreatmentTopical treatment consists of creams or ointments applied to the skin directly. Hydrocortisone, betamethasone, and fluticasone propionate are some of the commonly used topical corticosteroids for the treatment of atopic dermatitis. They are considered to be the most effective in the treatment of the disease. The side effects however are stretch marks and thinning of the skin and hence some patients hesitate in using this form of treatment. It should also not be used on the face or areas where the skin is thin. Antibiotics are prescribed along with the steroid treatment if there is an infection. Calcineurin inhibitors are topical immunosuppressants (pimecrolimus and tacrolimus) which work by weakening the immune system and used when other treatment options have failed. They are not recommended in children younger than 2 years of age. There can be side effects such as intense stinging or burning with these medications. Atopic dermatitis can worsen at night due to the warmth from the bed and can disrupt sleep. Sedating anti-histamines such as trimeprazine and hydroxyzine reduce itching and aid in sleep whenever it is interfering with sleep. When the rash is infected, antibiotic, antiviral, or antifungal medications are used accordingly. Apart from medications, there are other steps that can help alleviate atopic dermatitis: Avoid scratching if possible. Keep the skin hydrated through bathing and moisturizing the skin with lotion. Moisturizers provide an oily protective barrier that keeps the skin from drying up. Soft and smooth skin reduces itching. Bathe only for 3 to 5 minutes and use only warm water and do not use gels or bath oils. Use cold compress to reduce itching. Avoid soaps that dry the skin, perfumes, and scratchy clothing or bedding. Do not use harsh or strong soaps that dry the skin or perfumes or clothing or bedding that cause itchiness. Keep the area covered by bandage dressings. Mittens or cotton socks can help prevent babies with the rash from scratching and making the rash worse. Keep the nails trimmed to avoid damage to skin from scratching. Avoid the triggers or allergens that are known to cause the rash. These may include dust and dust mites, animal dander, certain foods (such as eggs, peanuts, milk, wheat, or soy products). Determining what type of allergen is causing the rash can help with the treatment of atopic dermatitis. Exposure to ultraviolet (UV) light is also seen to help atopic dermatitis in older children and adults. This can be carried out with or without additional medications. Depending on the type of skin, the initial exposure should not be more than 5 to 20 minutes with ultraviolet light therapy. This therapy should however be used in moderation and care should be taken to avoid sunburn and should be carried out under the supervision and direction of a dermatologist. Preventive measures along with moisturizing the skin, avoiding allergens or irritants, in combination with medications can help control atopic dermatitis. Different treatments have to be tried to find out which one works best. |
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