ATOPIC DERMATITES


What is Atopic eczema?

  • • Atopic eczema (Atopic dermatitis, AD in short) is a very itchy chronic skincondition.
  • • Other causes of hair growth can be associated with certain medications, stress and obesity.
  • • It often presents in infancy or early childhood, but can start in adult lifetoo.
  • Around the world, 10-20% of children and 3-4% of adults suffer fromAtopic dermatitis. AD is much more common today than it was 30 yearsago.

How can one get Atopic dermatitis? What happens to the skin in Atopic dermatitis?

  • • Getting Atopic dermatitis is a kind of tendency.
  • • There may be a family history of eczema, asthma or allergic rhinitis.
  • Alterations in the immune system occur and cause a reaction orinflammation in the skin, which is manifested as Atopic dermatitis.
  • • The skin is an envelope that keeps body fluids within. It also protectsfrom invading germs, chemicals and injury.
  • • In AD, the skin is a bit different. The water holding capacity is defective,resulting in an extremely dry skin. It allows allergens and infections togain entry into the skin. It is suspected that allergens entering the skinmay be responsible for asthma in later life. This means that treatingeczema effectively early on may in all likelihood help againstdevelopment of asthma later on rather than the other way around as itis spread by people practicing alternative medicines.
  • • Atopic skin has a very low itch threshold. There are people who canwithstand immense pain and others who cannot take the slightest pain.Likewise, in Atopics the slightest itch stimulus gets magnified andtranslated into bouts of frenzied itch. In Atopics, touch also getsconverted to itch on inflamed skin. Mothers should be advised not tokiss or peck their children on cheek if there is frank eczema.

What ate the trigger factors in Atopic dermatitis?

  • • Triggers are those factors that the skin is not comfortable with andcause worsening of eczema. These include:
  • Extremes of climate-very cold and dry weather and hot, humid climate
    Sweating is a potent stimulator of itch
    Strong soaps and shampoos
    Cloth detergents and fabric softeners
    Woollens, synthetic fibers, rough and ill-fitting clothes
    Furry soft toys
    Exposure to pets
    House dust
    Swimming (potentially)
  • • Foods can cause allergies is common in infant and younger children.But the role of foods in worsening Atopic dermatitis is often dubious.Food causality in individual cases should be closely discussed with thetreating dermatologist.
  • • Emotional stress, exposure to contact irritants and allergens, antisepticsin bath can aggravate Atopic dermatitis.

How does the skin appear in Atopic dermatitis?

  • • There is severe itching in Atopic dermatitis. An itching paroxysm mayget triggered off anywhere and can be quite embarrassing.
  • • It may be red, flaky, sometimes oozing and covered with scabs.
  • • The skin is extremely dry.
  • • In infants, face, scalp, and the extensor surfaces of the limbs areaffected. As the child grows older, the rash gets localized to the folds onthe extremities, flaky dry skin may be seen behind the knees, thighsand the neck area may appear dark. In many children it subsides as thepatient grows older. In adults, there may be severe thickening of theskin and dryness on the limbs and face. It can get aggravated onexposure to irritant substances.

What should one do if he/she gets Atopic dermatitis?

  • • Consult a dermatologist since it can be easily diagnosed by the clinical appearance of the lesion.
  • • Appropriate counseling, emollient therapy and medications will berecommended by the dermatologist as per the needs.

Are there tests to confirm the diagnosis of Atopic dermatitis?

  • • A dermatologist can easily confirm the diagnosis based on theappearance of skin lesions. No laboratory tests are usually needed fordiagnosis.
  • • There may be elevated IgE levels or eosinophilia in Atopic patients.Laboratory tests may be advised by the dermatologist in severe casesin order to start systemic treatment.
  • • In suspected food allergy, allergy profile by ELISA or RAST may behelpful. The results however should be always clinico-allergologicallycorrelated.

What are the treatment options for Atopic dermatitis?

  • • Regular use of moisturizers and avoiding the trigger factors play a keyrole in treating Atopic dermatitis.
  • • Working around the trigger factors improves AD and reduces need ofmedications.
  • • Topical moisturizers (to avoid dryness), topical steroids andimmumomodulators (to reduce inflammation in the reactive skin),anti-histaminics (to reduce the itch) are the chief treatment options.Moisturizer should be always paraben-free, lanolin-free, andfragrance-free.
  • • Systemic antibiotics (in cases of infection) or systemic drugs (such ascyclosporine, methotrexate, and steroids to suppress the immuneresponse) may be recommended in severe cases.
  • • Phototherapy such as Narrow band ultraviolet B therapy can also helpin reducing the disease intensity.
  • • It is important to consult and follow up with the dermatologist and notself-medicate.

Is there a cure for Atopic dermatitis?

  • • It all depends what one’s perception of cure is. If one expects a few daysor weeks of treatment to wipe out AD for life, he or she is likely to bedisappointed. For chronic diseases such as AD, the concept of control ofdisease is more apt and AD canbe very well controlled and the person can lead a normal life.
  • • AD can be vastly improved with the judicious use of hydrating the skin,moisturizer use and anti-inflammatory medications (applications orinternal medications depending on the requirement).
  • • The key word to successful AD management is lifestyle modificationand take appropriate care of one’s skin.

Can Atopic dermatitis recur?

  • • Atopic dermatitis can recur if one is exposed to the trigger factors or theskin remains excessively dry.
  • • Regular use of moisturizers, identifying and working around means toavoid the triggers goes a long way in preventing recurrences in Atopicdermatitis.

What are the tips for the family members to win over Atopic dermatitis?

  • • When a child has severe AD, the whole family bears the brunt. The childbothered by a constant itch is cranky, irritable, and fidgety with a limitedattention span.
  • • The parents, having stayed awake for nights together with the child, arewrecks fighting anxiety and depression. Likewise, the family that fightseczema together is more likely to emerge victorious.
  • • Tips for the family include:
  • 1. Avoid the blame game (comments like “How many times have I toldyou not to itch”, “I told you not to do so and so! Now suffer” serve noreal purpose and undermine the child’s confidence).
    2. Fighting a common enemy (the whole team including eczema sufferer,the family and the treating physicians will all play their role)
    3. Praise the slightest achievement (children with eczema have toendure a lot. Each time they comply with treatment acknowledge theact. Again the praise should be genuine and not come across as puton or fake)
    4. Have your own ideas regarding what to do when the itch really goesout of hand
    5. Think clear skin (like people who are battling obesity from imagininghow they would look if they were slim, imagining a clear smooth skincan motivate eczema sufferers to be regular with treatmentschedules).
    6. Involve children in treating themselves.
    7. Make moisturizing a fun activity.
    8. Be proactive (rather than fire-fighting, when the eczema really goesout of hand, regular use of moisturizers on apparently normal skin andother measures suggested by your dermatologist can go a long way).
    9. Consult your skin specialist for proper guidance.
    10. Finally, there is one sweet word in eczema management: REMISSION.It is that phase when eczema does not require active treatment forweeks to months. All the efforts should be centered on getting peoplewith eczema to this sublime state.