Eczema

Atopic Dermatitis - Know It All!

Editorial

Atopic Dermatitis — Know It All!

All you need to know about Eczema.

Eczema
Eczema

Know your ailment well, so you can manage it better!!

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Overview:

Atopic Dermatitis is also referred to as Eczema, commonly.

Atopic dermatitis also referred to as eczema, is a chronic (long-lasting) disease that causes the skin to become inflamed, red, and irritated. It’s a chronic disorder that typically begins in childhood; however, anyone can get the illness. Atopic dermatitis is not infectious, so it can not be transmitted from person to person.

Atopic dermatitis causes excessively itchy skin. Scratching contributes to more redness, swelling, cracking, crusting, and scaling of the transparent fluid. For most cases, there are occasions when the disease gets worse, called flares, followed by periods where the skin improves or even clears up, called remissions.

Scientists do not know what causes atopic dermatitis, although they do know that the disease plays a part in genes, the immune system and the environment. It may be difficult to live with atopic dermatitis depending on the severity and location of the symptoms. Treatment can help in controlling symptoms. In several, atopic dermatitis improves over maturity, but for others, it may be a chronic illness.

Eczema
Eczema

Who Develops Eczema?

  • Atopic dermatitis is a chronic disease that typically occurs during childhood and infancy. Atopic dermatitis goes away for many children before puberty. Many kids who experience atopic dermatitis, however, can tend to have symptoms as adults and adolescents. Occasionally the disorder occurs first during puberty for certain individuals.
  • There is a greater risk of developing atopic dermatitis if there is a family history of atopic dermatitis, hay fever or asthma. Moreover, evidence indicates that atopic dermatitis is more common in black children who are not Hispanic and that women and girls continue to develop the disease significantly more frequently than men and boys.

Causes:

No one knows what causes atopic dermatitis; however, researchers are aware that changes in the skin’s protective layer that cause it to lose humidity. It can cause the skin to get dry, resulting in skin damage and inflammation. New research suggests that itch sensations are directly caused by inflammation which in turn causes the patient to scratch. This contributes to further skin damage, as well as an increased risk of bacterial infection.

Researchers do know that the following can lead to changes in the skin barrier, which regulates moisture critically:

  • Changes in DNA, (mutations).
  • Immune system problems.
  • Exposure to other external issues.

Genetics

If there is a family history of the disease, the risk of developing atopic dermatitis is higher, which means that genetics may play a part in the cause. Scientists recently identified changes to genes that regulate a specific protein and help our bodies maintain a healthy skin layer. Without this protein’s normal levels, the skin barrier improves, allowing moisture to escape, and exposing the skin immune system to the environment , resulting in atopic dermatitis.

Scientists are continuing to research genes in order to better understand how different mutations cause atopic dermatitis.

Immunology

The immune system usually helps the body ward off illness, bacteria, and viruses. Occasionally the immune system is confusing and overactive, leading to atopic dermatitis, which can cause inflammation in the skin.

Environment:

External conditions can cause the immune system to change the skin’s protective barrier to allow more moisture to escape, which can contribute to atopic dermatitis. This may include:

  • Exposure to smoke from tobacco.
  • Many forms of toxins at the surface.
  • Many chemicals and fragrances present in skin products and soaps.
  • Extra dry skin.

Eczema
Eczema

Common symptoms of Eczema are as follows:

Itching is the most common symptom of atopic dermatitis and can be severe. Many common signs include:

  • Dark, with dry skin spots.
  • Rashes which, when scratched, may ooze, weep clear fluid or bleed.
  • Thickened and hardened skin.

The symptoms can manifest concurrently in several areas of the body, and may occur in the same locations and in new locations. The rash ‘s appearance and location varies depending on age; however the rash may appear anywhere on the body.

Infants:

During infancy and up to 2 years of age, red rash, which may ooze when rubbed, occurs most often on the:

  • Face.
  • Scalp.
  • Skin layer around the joint that brushes when the joint bends.

Many parents are concerned that the child has atopic dermatitis in the diaper area; however, this area rarely shows up the disease.

Childhood:

A red thickened rash, which may ooze or bleed when scratched, appears most commonly during childhood, usually 2 years of age to puberty, on the:

Elbows and knees, often in bend.

Neck and Ankles.

Eczema
Eczema

Teenagers and adults:

A red to dark brown scaly rash, which may bleed and crust when scratched, appears most commonly during the teenage and adult years on the:

  • Feet.
  • Hands.
  • Neck.
  • Elbows and knees, often in bend.
  • The skin around the eyes.
  • Ankles and feet.

Other skin characteristics common to atopic dermatitis include:

  • Extra skin folds beneath the eye, known as the Dennie-Morgan fold.
  • Skin darkening beneath the eyes.
  • On the palms of the hands and soles of the feet, extra skin creases.

Additionally, atopic dermatitis patients often have other conditions, such as:

  • Asthma and allergies like allergies to food.
  • Other skin conditions such as ichthyosis cause dry, thickened skin.
  • Depression, or fear.
  • Loss of Sleep.

Researchers continue to research why having atopic dermatitis as a child can cause asthma and hay fever to develop later in life.

Atopic dermatitis can be complicated. They cover:

  • Infections of bacterial skin which can worsen from scratching. These are common and can take control of the disease more difficult.
  • Viral infections in the skin.
  • Loss of sleep which can lead to behavioral problems in children.
  • Eczema to the hand (hand dermatitis).
  • Problems with the hand, such as:
  • Conjunctivitis (pink skin), which causes the inside of your eyelid and the white portion of your skin to swell and turn glow.
  • Blepharitis, which causes the eyelid to become progressively inflamed and swollen.

How is it Diagnosed?

Diagnosing atopic dermatitis may include the following:

Giving the doctor your or your child’s medical history, including:

  • Your family history of allergies.
  • Whether you also have diseases such as hay fever, asthma, or food allergies.
  • Sleep problems.
  • Foods that seem to trigger hives.
  • Previous treatments for skin-related symptoms.
  • Use of steroids or other medications.
  • Exposure to irritants, such as:

Soaps and detergents.

Some perfumes and cosmetics.

Cigarette smoke.

  • Examining your skin and the rash.

Ordering laboratory tests, such as:

  • Blood tests to check for other causes of the rash.
  • Skin biopsy of the rash or lesion.

Your doctor may need to see you or your child several times to make an accurate diagnosis and to determine if symptoms are from other diseases and conditions or from atopic dermatitis.

Treatment Options:

The goals for treating atopic dermatitis include the following :

  • Manage and control dry skin.
  • Contain skin inflammation.
  • Control itching.
  • Promote healing.
  • Prevent infections.
  • Prevent flares.

Eczema
Eczema

Your health care provider will work with you to develop a treatment plan based on:

  • Location and rash form including the severity of itching.
  • Specific triggers for you or your kids, to reduce exposure and to prevent possible flares.
  • The reaction of the skin to specific treatments, to identify which treatments appear to work best.

Treatments include usually a combination of therapies and may include:

Medications:

  • Moisturizing creams can help restore the skin barrier.
  • Corticosteroid creams and ointments help to decrease inflammation and are commonly used to treat diseases affecting the skin. Doctors do not usually prescribe oral corticosteroids to treat atopic dermatitis because after stopping the normal dose, atopic dermatitis can flare or rebound and be more severe than before.
  • Calcineurin inhibitors applied to the skin decrease inflammation and help prevent flares
  • Phosphodiesterase-4 inhibitors, a topical cream, can help with inflammation when the symptoms do not respond to other treatments
  • Pills that reduce the abnormal immune response can be used but are reserved for more severe disease, and they require close monitoring.
  • Biologic medication, which is given by an injection just under the skin, blocks specific functions of the immune system to help control and manage atopic dermatitis. At this time, biologic medications are only approved to treat adults and adolescents with the condition

Skin Care:

When treating atopic dermatitis it is necessary to keep the skin hydrated by applying moisturizers immediately after bathing to retain the water in your skin. The doctor will decide how much you or the child will take a bath and what kind of moisturizer you should use. For certain cases, the following skincare may be advised to do with AD:

  • Twice a week, diluted bleach bath to help treat AD and prevent infections. It is important when taking a bleach bath, to follow the specific instructions of your doctor. You do not take this medication without talking to the doctor first.
  • Wet wrap treatment to help moisturize the skin when the disease continues. Just use wet wraps, though, after talking to your doctor.

Phototherapy:

If the atopic dermatitis is severe, widespread, and has not responded to other therapies, the use of ultraviolet A or B light waves to relieve symptoms may be recommended.

When atopic dermatitis causes you or your child to develop skin infections, your doctor can prescribe additional topical or oral antibiotic treatments.

It is important to use skin treatments as directed and to periodically follow up with your doctor to ensure that the treatment plan works.

References:

Generalized Dermatitis in Clinical Practice

Rook’s Textbook of Dermatology, 4 Volume Set (9 ed.). John Wiley & Sons. 2016. ISBN 9781118441176. Archived from the original on 15 August 2016. Retrieved 29 July 2016.

https://www.niams.nih.gov/health-topics/atopic-dermatitis/

By,

Gopala Krishna Varshith,

Content Developer & Editor,

Clipo.

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