ATOPIC DERMATITIS

What Is Atopic Dermatitis?

Atopic dermatitis is a common, often persistent skin disease that affects a large percentage of the world’s population. Atopy is a special type of allergic hypersensitivity that is associated with asthma, inhalant allergies (hay fever), and a chronic dermatitis. There is a known hereditary component of the disease, and it is more common in affected families. Criteria that enable a health consultant to diagnose it include the typical appearance and distribution of the rash in a patient with a personal or family history of asthma and/or hay fever. The term atopic is from the Greek meaning “strange.” The term dermatitis means inflammation of the skin. Many physicians and patients use the term eczema when they are referring to this condition. Sometimes it is called neurodermatitis.

In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, vesicle formation (minute blisters), cracking, weeping, crusting, and scaling. This type of eruption is termed eczematous. In addition, dry skin is a very common complaint in almost all those afflicted with atopic dermatitis.

Although atopic dermatitis can occur in any age, most often it affects infants and young children. Occasionally, it may persist into adulthood or may actually appear at that time. Some patients tend to have a protracted course with ups and downs. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, which are followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis enter into a permanent remission of the disease when they get older, although their skin may remain somewhat dry and easily irritated.

Multiple factors can trigger or worsen atopic dermatitis, including low humidity, seasonal allergies, exposure to harsh soaps and detergents, and cold weather. Environmental factors can activate symptoms of atopic dermatitis at any time in the lives of individuals who have inherited the atopic disease trait.

What are the causes and risk factors of atopic dermatitis?

The cause of atopic dermatitis is not known, but the disease seems to result from a combination of genetic (hereditary) and environmental factors. There seems to be a basic cutaneous hypersensitivity and an increased tendency toward itching. Evidence suggests that the disease is associated with other so-called atopic disorders such as hay fever (seasonal allergies) and asthma, which many people with atopic dermatitis also have. In addition, many children who outgrow the symptoms of atopic dermatitis go on to develop hay fever or asthma. Although one disorder does not necessarily cause another, they may be related, thereby giving researchers clues to understanding atopic dermatitis. Many of those affected seem to have either a decreased quantity of or a defective form of a protein called filaggrin in their skin. This protein seem to be important in maintaining normal cutaneous hydration. It is important to understand that food sensitivities do not seem to be a major inciting factor for most cases of atopic dermatitis. This is an area of active research. Patients with atopic dermatitis seem to have mild immune system weakness. They are predisposed to develop fungal foot disease and cutaneous staphylococcal infections, and they can disseminate herpes simplex lip infections (eczema herpeticum) and smallpox vaccination (eczema vaccinatum) to large areas of skin.

While emotional factors and stress may sometimes exacerbate the condition, they do not seem to be a primary or underlying cause for the disorder.

What are atopic dermatitis symptoms and signs?

lthough symptoms and signs may vary from person to person, the most common symptoms are dry, itchy, red skin. Itch is the hallmark of the disease. Typically, affected skin areas include the folds of the arms, the back of the knees, wrists, face, and neck.

The itchiness is an important factor in atopic dermatitis, because scratching and rubbing can worsen the skin inflammation that is characteristic of this disease. People with atopic dermatitis seem to be more sensitive to itching and feel the need to scratch longer in response. They develop what is referred to as the “itch-scratch” cycle. The extreme itchiness of the skin causes the person to scratch, which in turn worsens the itch, and so on. Itching is particularly a problem during sleep, when conscious control of scratching decreases and the absence of other outside stimuli makes the itchiness more noticeable.

Atopic Dermatitis Treatment Options

Finding a good prevention and treatment plan for AD is essential for managing symptoms. Untreated AD will continue to itch and lead to more scratching. Once you start scratching, you’re at greater risk of infection.

Effective treatment can help you maintain a higher quality of life and get better sleep. Both are essential for reducing stress, which can lead to increased flare-ups.

While there isn’t a cure for AD, there are different treatment options.

MOISTURIZERS

Moisturizing the skin is one of the simplest and most effective AD treatments. To relieve the dry skin caused by AD, you must add moisture to the skin. The best way to do this is to apply a moisturizer immediately after bathing, while the skin is still damp.

OTC moisturizers are a good long-term treatment solution. There are three different types of moisturizers:

Lotions

Lotions are the lightest moisturizers. Lotion is a mix of water and oil that you can easily spread over the skin. However, the water in lotion evaporates quickly, so it may not be the best choice for severe AD.

Creams

A cream is a semisolid mixture of oil and water. The oil content is higher in cream than in lotion. Creams are more emollient than lotion, meaning that they better hydrate the skin. Creams are a great daily moisturizing option for chronically dry skin.

Ointments

Ointments are semisolid greases with very high oil content and much less water than lotions and creams. Ointments are very moisturizing and should only have a few ingredients.

The simplest ointment is petroleum jelly, which only has one ingredient. This makes ointments a good option for those with sensitive skin. Because these formulations feel greasy on the skin, it might be best to apply them before bed.