Atopic Dermatitis - Frequently Asked Questions
Infantile and Childhood Eczema Revisited
Aug 26, 2009
Atopic dermatitis is a chronically relapsing inflammatory skin disease, usually starting in infancy, and characterized by intense itching and dry skin. Following are a few common doubts regarding the cause, exacerbation, clinical features and treatment of atopic eczema.
What is Atopic Dermatitis?
As the name indicates, atopic dermatitis involves atopy and dermatitis. Atopy literally means ‘out of place’ or ‘different’ and refers to a tendency to develop allergic skin disease, asthma and/or nasal allergy. Dermatitis denotes inflammation of the skin and is used synonymously with eczema.
Is Atopic Tendency Inherited?
Yes, 70% of patients with atopic dermatitis have close relatives with at least one of the 3 atopic illnesses. Patients with atopic dermatitis have an inherently irritable skin with itching being the most prominent symptom of the skin disease.
How to Diagnose Atopic Dermatitis?
The following are the major criteria through which atopic dermatitis is diagnosed:
- Pruritus or itching of varying severity
- Typical appearance and distribution of the skin rashes of various stages of eczema according to the age (see below).
- Acute, sub acute or chronic dermatitis which is recurrent: known as chronically relapsing dermatitis.
- Personal or family history of atopic diathesis.
- In addition, laboratory tests may show increased IgE and eosinophilia.
How Does Atopic Dermatitis Change According to Age?
Atopic dermatitis can start at any age, though more than 60% patients have their first attack before the age of 1 year(as early as 2 months of age in some) and 90% have had their first outbreak before the age of 5. 4 phases are seen in atopic dermatitis, according to the ages.
- Infantile Atopic Dermatitis (up to 2 years of age): Presents as intensely itchy red skin rashes on the cheeks, forehead, and scalp. Body is comparatively spared, though milder rashes may be present on the front of legs. Fluid filled vesicles, oozing and crusting are present within the itchy skin rashes. Half of the patients clear by the age of 3 years.
- Childhood Atopic Dermatitis (3 – 11 years): There are more of crusted (sub acute) and chronic, thickened skin rashes now; less of the moist lesions of the acute eczema. Wrists, ankles, back of thighs, buttocks, front of elbows and back of knees are involved in the childhood variety of atopic dermatitis. Two third of the patients are clear by the age of 6 years.
- Adolescent Atopic Dermatitis (12 – 20 years): Dry, thick, lichenified itchy skin rashes are seen more on the face, neck, upper arm, back and flexural (bending) aspect of the elbows, wrists, knees and ankles.
- Adult Atopic Dermatitis (Above 21 years): About 10-20% of cases of atopic dermatitis cases continue into adult phase. The skin lesions are typically the chronic variety of eczema, with thickening, lichenification and pigmentation of the skin. Extensor aspects of the limbs, face and neck, and, rarely, the body may be involved.
What are the Exacerbating Factors in Atopic Eczema?
Though it is a genetically predisposed skin disease, atopic dermatitis is influenced by a variety of psychological, environmental and biological factors. Excessive bathing without proper lubrication is the commonest cause of irritation in an atopic patient. Topical irritants like synthetic and woolen fabrics, dust, mineral oils and detergents, and excessive perspiration brings out itchy outbreaks of the atopic eczema. House dust mites and other air borne particles from smoke, animal fur, molds etc exacerbate the symptoms of atopic dermatitis. Some food items can also cause exacerbation of the dermatitis. In addition, secondary infections with the Staph or Pityrosporum species can also induce a fresh outbreak of the disease.
Is Food Allergy a Contributing Factor in the Exacerbation of Atopic Dermatitis?
Many studies have pointed towards certain food items as causing exacerbations of atopic dermatitis. Milk, eggs, nuts, soy, wheat and sea food are the most common allergens implicated as the offending agents. Food allergy as the inducer or exacerbator of atopic dermatitis is still a controversial subject among dermatologists, pediatricians and allergists. Elimination diets should be advised cautiously as the real danger of inducing malnutrition is always there in such cases.
Is There a Cure for Atopic Dermatitis?
No, atopic dermatitis cannot be cured, but can be effectively kept under control with a variety of measures like avoiding the provoking factors, taking steps to reduce the skin dryness, control of infection and treatment of the atopic eczema with judicious use of topical steroids and emollients.
Suppression of flare ups involves use of topical pimecrolimus or tacrolimus and emollients. Oral sedating antihistamines relieve itching associated with atopic dermatitis..
Reference
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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