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 chronic dermatitis. There is a known hereditary component of the disease, and it is more common in affected families. Criteria that enable a doctor 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. 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. Atopic dermatitis can occur in any age, most often it affects infants and young children. Occasionally, it may persist into adulthood. 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.
Atopic Dermatitis vs Eczema
Eczema is a nonspecific term for many types of skin inflammation (dermatitis). There are different categories of eczema, which include allergic, contact, irritant, and nummular eczema, which can be difficult to distinguish from atopic dermatitis.
Types of eczema
- Contact eczema: a localized reaction that includes redness, itching, and burning where the skin has come into direct contact with an irritant such as an acid, a cleaning agent, or other chemical.
- Allergic contact eczema: a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain chemicals or antibiotics in creams and lotions like neomycin (Neosporin) or bacitracin.
- Seborrheic eczema (also called seborrheic dermatitis or seborrhea) is a very common form of mild skin inflammation of unknown cause that presents as yellowish, oily, scaly patches of skin on the scalp, face, ears, and occasionally other parts of the body. Often this is also called dandruff in adults or "cradle cap" in infants.
- Nummular eczema: coin-shaped (round), isolated patches of irritated skin -- most commonly on the arms and lower legs -- that may be crusted, scaling, and extremely itchy
- Lichen simplex chronicus (localized neurodermatitis): dermatitis localized to a particular anatomical area induced by long-term rubbing, scratching, or picking the skin. The underlying cause may be a sensitivity or irritation that sets off a cascade of repeated itching and scratching cycles. It may be seen as scratch marks and pick marks. Areas of thickened plaques form on the skin of the neck, shins, wrists, or forearms.
- Stasis dermatitis: a skin irritation on the lower legs, generally related to circulatory problems and congestion of the leg veins. It may have a darker pigmentation, light-brown, or purplish-red discolouration from the congestion and back up of the blood in the leg veins. It's sometimes seen more in legs with varicose veins.
- Dyshidrotic eczema or pompholyx: irritation of the skin on the palms of hands (mostly) and less commonly soles of the feet characterized by clear, very deep-seated blisters that itch and burn. It's sometimes described as a "tapioca pudding"-like rash on the palms.
- Xerotic eczema: areas of very dry skin most often seen on the lower legs of the elderly.
Is Atopic Dermatitis contagious?Atopic dermatitis itself is definitely not contagious, and it cannot be passed from one person to another through skin contact. There is generally no cause for concern in being around someone with even an active case of atopic dermatitis
Signs and symptomsAlthough 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.
Can atopic dermatitis affect the face?Atopic dermatitis may affect the skin around the eyes, the eyelids, the eyebrows, and lashes. Scratching and rubbing the eye area can cause the skin to change in appearance. Some people with atopic dermatitis develop an extra fold of skin under their eyes, called an atopic pleat or Dennie-Morgan fold.The skin on their eyelids darkens from the inflammation or hay fever (allergic shiners). Patchy eyebrows and eyelashes may also result from scratching or rubbing. The face is very commonly affected in babies, who may drool excessively, and become irritated from skin contact with their abundant saliva. The skin of a person with atopic dermatitis loses excessive moisture from the epidermal layer. In addition, the skin is very susceptible to infectious disorders, such as staphylococcal and streptococcal bacterial skin infections, warts, herpes simplex, and molluscum contagiosum (which is caused by a virus).
What are the stages of atopic dermatitis?Atopic dermatitis seems to have a differing pattern of involvement depending on the age of a patient. In infants, atopic dermatitis typically begins around 6 to 12 weeks of age. It may first appear around the cheeks and chin as a patchy facial rash, which can progress to red, scaling, oozing skin. The skin may become infected. Once the infant becomes more mobile and begins crawling, exposed areas such as the knees and elbows may also be affected. An infant with atopic dermatitis may be restless and irritable because of the itching and discomfort. Many infants improve by 18 months of age, although they remain at greater than normal risk for dry skin or hand eczema later in life.In childhood, the rash tends to occur behind the knees and inside the elbows, on the sides of the neck, and on the wrists, ankles, and hands. Often, the rash begins with papules that become hard and scaly when scratched. The skin around the lips may be inflamed, and constant licking of the area may lead to small, painful cracks. Severe cases of atopic dermatitis may affect growth, and the child may be shorter than average. In those with more heavily pigmented skin, especially the face, areas of lighter skin colour appear. This condition is called pityriasis alba. It is usually self-limited and the colour will eventually normalize. The disease may go into remission (disease-free period) for months or even years.In most children, the disease disappears after puberty. Although a number of people who developed atopic dermatitis as children also experience symptoms as adults, it is less common for the disease to show up first in adulthood. The pattern in adults is similar to that seen in children; that is, the disease may be widespread or limited. In some adults, only the hands or feet may be affected and become dry, itchy, red, and cracked. Sleep patterns and work performance may be affected, and long-term use of medications to treat the condition may cause complications. Adults with atopic dermatitis also have a predisposition toward irritant contact dermatitis, especially if they are in occupations involving frequent hand wetting, hand washing, or exposure to chemicals. Some people develop a rash around their nipples.These localized symptoms are difficult to treat, and people often do not tell their doctor because of modesty or embarrassment. Adults may also develop cataracts that are difficult to detect because they cause no symptoms. Therefore, the doctor may recommend regular eye exams
What are skin irritants in patients with atopic dermatitis?Irritants are substances that directly damage the skin, and when used in high enough concentrations for long enough, cause the skin to become inflamed. Soaps, detergents, and even water may produce inflammation. Some perfumes and cosmetics may irritate the skin. Chlorine and alcoholic solvents, dust, or sand may also aggravate the condition. Cigarette smoke may irritate the eyelids.
- Wool or synthetic fibres
- Wool or synthetic fibres
- Soaps and detergents
- Some perfumes and cosmetics
- Substances such as chlorine, mineral oil, or solvents
- Dust or sand
- Dust mites
- Cigarette smoke
- Animal fur or dander
- Flowers and pollen
- Food allergy
What are home remedies for atopic dermatitis?Treatment involves a partnership between the doctor and the patient and family members. The doctor will suggest a treatment plan based on the patient's age, symptoms, and general health. The patient and family members play a large role in the success of the treatment plan by carefully following the doctor's instructions. Some of the primary components of treatment programs are described below. Most patients can be successfully managed with proper skincare and lifestyle changes and do not require the more intensive treatments discussed.Skincare: A simple and basic regimen is key. Staying with one recommended soap and one moisturizer is very important. Using multiple soaps, lotions, fragrances, and mixes of products may cause further issues and skin sensitivity. Healing the skin and keeping it healthy is of primary importance both in preventing further damage and enhancing the patient's quality of life. Developing and following a daily skincare routine is critical to preventing recurrent episodes of symptoms. The key factor is proper bathing and the application of an emollient to the wet skin without towel drying. Generally, an effective emollient is a reasonably stiff ointment or cream (one that does not move out of an opened inverted jar). People with atopic dermatitis should avoid hot baths and showers.Another key to protecting and restoring the skin is taking steps to avoid repeated skin infections. Although it may not be possible to avoid infections altogether, the effects of an infection may be minimized if they are identified and treated early. Patients and their families should learn to recognize the signs of skin infections, including tiny pustules (pus-filled bumps) on the arms and legs, the appearance of oozing areas, or crusty yellow blisters. If symptoms of a skin infection develop, the doctor should be consulted to begin treatment as soon as possible. Treating atopic dermatitis in infants and children
- Give lukewarm baths.
- Apply an emollient immediately following the bath.
- Keep a child's fingernails filed short.
- Select soft cotton fabrics when choosing to clothe.
- Consider using antihistamines to reduce scratching at night.
- Keep the child cool; consider a humidifier.
- Learn to recognize skin infections and seek treatment promptly.
- Attempt to distract the child with activities to keep him or her from scratching.
What is the treatment for atopic dermatitis?
Corticosteroid creams and ointments are the most frequently used treatment. Since many of these are quite potent it will be necessary to have frequent physician visits to assure that the treatment is successful. Tacrolimus and pimecrolimus are non-steroid topical ointments. A newer class of OTC (over the counter) creams have been recently developed which claim to repair and improve the skin's barrier function in both children and adults.
These creams may be used in combination with topical steroids and other emollients to help repair the overall dryness and broken skin function. Additional available treatments may help to reduce specific symptoms of the disease. Oral antibiotics to treat staphylococcal skin infections can be helpful in the face of pyoderma. Certain antihistamines that cause drowsiness can reduce nighttime scratching and allow more restful sleep when taken at bedtime. This effect can be particularly helpful for patients whose nighttime scratching aggravates the disease. If viral or fungal infections are present, the doctor may also prescribe medications to treat those infections.
When other treatments are not effective, the doctor may prescribe systemic corticosteroids, drugs that are taken by mouth or injected into a muscle instead of being applied directly to the skin. An example of a commonly prescribed corticosteroid is prednisone. Typically, these medications are used only in resistant cases and are only given for short periods of time In adults, immunosuppressive drugs are also used to treat severe cases of atopic dermatitis that have failed to respond to any other forms of therapy. Immunosuppressive drugs restrain the overactive immune system by blocking the production of some immune cells and curbing the action of others.
Atopic dermatitis and quality of lifeDespite the symptoms caused by atopic dermatitis, it is possible for people with the disorder to maintain a high quality of life. The keys to an improved quality of life are education, awareness, and developing a partnership among the patient, family, and doctor. Good communication is essential for all involved. It is important that the doctor provides understandable information about the disease and its symptoms to the patient and family and demonstrate any treatment measures recommended to ensure that they will be properly carried out. When a child has atopic dermatitis, the entire family situation may be affected.It is important that families have additional support to help them cope with the stress and frustration associated with the disease. The child may be fussy and difficult and often is unable to keep from scratching and rubbing the skin. Distracting the child and providing as many activities that keep the hands busy are key but require effort and work on the part of the parents or caregivers.
What is the prognosis of atopic dermatitis?Although symptoms of atopic dermatitis can be very difficult and uncomfortable, the disease can be successfully managed. People with atopic dermatitis, as well as their families, can lead healthy, normal lives. Long-term management may include treatment with an allergist to control inhalant allergies and a dermatologist to monitor the skincare component.