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ATOPIC DERMATITIS. Definition. Atopic dermatitis is a very common, often chronic (long-lasting) skin disease that affects a large percentage of the world's population. It is also called eczema, dermatitis, or atopy. Most commonly, it may be thought of as a type of skin allergy or sensitivity. .
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Definition Atopic dermatitis is a very common, often chronic (long-lasting) skin disease that affects a large percentage of the world's population. It is also called eczema, dermatitis, or atopy. Most commonly, it may be thought of as a type of skin allergy or sensitivity.
The atopic dermatitis triad includes asthma, allergies (hay fever), and eczema. There is a known hereditary component of the disease, and it is seen more in some families. The hallmarks of the disease include skin rashes and itching.
ATOPIC DERMATITIS The skin of a patient with atopic dermatitis reacts abnormally and easily to irritants, food, and environmental allergens and becomes red, flaky and very itchy. It also becomes vulnerable to surface infections caused by bacteria. The skin on the flexural surfaces of the joints (for example inner sides of elbows and knees) are the most commonly affected regions in people.
The word "dermatitis" means inflammation of the skin. "Atopic" refers to diseases that are hereditary, tend to run in families, and often occur together. In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, cracking, weeping, crusting, and scaling. Dry skin is a very common complaint and an underlying cause of some of the typical rash symptoms.
Although atopic dermatitis can occur in any age, most often it affects infants and young children. In some instances, it may persist into adulthood or actually first show up later in life. A large number of patients tend to have a long-term course with various 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.
Triggers Multiple factors can trigger or worsen atopic dermatitis, including dry skin, seasonal allergies, exposure to harsh soaps and detergents, new skin products or creams, 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.
Scientists estimate that 65% of patients develop symptoms in the first year of life, and 90% develop symptoms before the age of 5. Onset after age 30 is less common and often occurs after exposure of the skin to harsh conditions. People who live in urban areas and in climates with low humidity seem to be at an increased risk for developing atopic dermatitis.
About 10% of all infants and young children experience symptoms of the disease. Roughly 60% of these infants continue to have one or more symptoms of atopic dermatitis even after they reach adulthood.
The itchy feeling is an important factor in atopic dermatitis, because scratching and rubbing in response to itching 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. Many patients also notice worsening of their itch in the early evening when they get home from work or school when there are less external stimuli to keep them occupied. When things at home sort of quiet down, the itching seems to become more noticeable.
Major and minor features of atopic dermatitis Major features Itching Characteristic rash in locations typical of the disease (arm folds and behind knees) Chronic or repeatedly occurring symptoms Personal or family history of atopic disorders (eczema, hay fever, asthma)
Some minor features Early age of onset Dry, rough skin High levels of immunoglobulin E (IgE), an antibody, in the blood Ichthyosis Hyper linear palms Keratosis pilaris Hand or foot dermatitis Cheilitis (dry or irritated lips) Nipple eczema Susceptibility to skin infection Positive allergy skin tests
Conditions aggravating AD Many factors or conditions can intensify the symptoms of atopic dermatitis, including dry skin, winter or cold weather, wool cloths, and other irritating skin conditions. These factors may further trigger the itch-scratch cycle, further stimulating the many times already overactive immune system in the skin. Repeated aggravation and activation of the itch-scratch cycle may cause further skin damage and barrier breakdown. These exacerbating elements can be broken down into two main categories: irritants and allergens. Emotional factors and some infections can also influence atopic dermatitis.
Management Although there is no cure for atopic eczema, and its cause is not well understood, it can be treated very effectively in the short term through a combination of prevention (learning what triggers the allergic reactions) and drug therapy.
Management Most patients can be successfully managed with proper skin care and lifestyle changes and do not require the more intensive treatments discussed. Much of the improvement comes from homework, including lubricating generously especially right after showers or baths.
Management The doctor should have three main goals in treating atopic dermatitis: healing the skin and keeping it healthy preventing flares, and treating symptoms when they do occur. Much of caring for the skin involves developing skin-care routines, identifying exacerbating factors, and avoiding circumstances that stimulate the skin's immune system and the itch-scratch cycle. It is important for the patient and family members to note any changes in skin condition in response to treatment and to be persistent in identifying the most effective treatment strategy.
Management 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 are of primary importance both in preventing further damage and enhancing the patient's quality of life. Developing and following a daily skin care routine is critical to preventing recurrent episodes of symptoms. Key factors are proper bathing and the application of lubricants, such as creams or ointments, within three minutes of bathing.
Management People with atopic dermatitis should avoid hot or long (more than 10 to 15 minutes) baths and showers. A lukewarm bath helps to cleanse and moisturize the skin without drying it excessively. Bath oils are not usually helpful.
Management Once the bath is finished, the patient should air-dry the skin or pat it dry gently (avoiding rubbing or brisk drying) and apply a lubricant immediately. Lubrication restores the skin's moisture, increases the rate of healing, and establishes a barrier against further drying and irritation. Several kinds of lubricants can be used. Lotions generally are not the best choice because they have a high water or alcohol content and evaporate quickly. Creams and ointments work better at healing the skin. Tar preparations can be very helpful in healing very dry, lichenified areas. Whatever preparation is chosen, it should be as free of fragrances and chemicals as possible.
Management 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, 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 brief, lukewarm baths. Apply lubricant immediately following the bath. Keep a child's fingernails filed short. Select soft cotton fabrics when choosing clothing. Consider using antihistamines to reduce scratching at night. Keep the child cool; avoid situations where overheating occurs. Learn to recognize skin infections and seek treatment promptly. Attempt to distract the child with activities to keep him or her from scratching.
Controlling atopic dermatitis Lubricate the skin frequently. Avoid harsh soaps and cleansers. Prevent scratching or rubbing whenever possible. Protect skin from excessive moisture, irritants, and rough clothing. Maintain a cool, stable temperature and consistent humidity levels. Limit exposure to dust, cigarette smoke, pollens, and animal dander. Recognize and limit emotional stress.
Prevention Since there is no cure for atopic eczema, treatment should mainly involve discovering the triggers of allergic reactions and learning to avoid them. Diet: Originally controversial, the association of food allergy with atopic dermatitis has now been clearly demonstrated. Many common food allergens can trigger an allergic reaction: such as milk, nuts, cheese, tomatoes, wheat, yeast, soy, and corn. Many of these allergens are common ingredients in grocery store products (especially corn syrup, which is a sugar substitute).
Prevention Specialty health food stores often carry products that do not contain common allergens. If a child avoids these allergens early on, the frequency of reactions to these later in life is decreased significantly. Breastfeeding is the best way to avoid these problems, but if that is unavailable, then hydrolyzed formulas are preferred to cow's milk.
Prevention Environment and Lifestyle: Since dust is a very common allergen and irritant, adults with atopic eczema should likely avoid smoking, as well as the inhalation of dust in general. The dander from the fur of dogs and cats may also trigger an inflammatory response. It is a common misconception that simply removing an animal from a room will prevent an allergic reaction from occurring.
Prevention A room must be completely free of animal dander in order to prevent an allergic reaction. Anger, stress, and lack of sleep are also factors that are known to aggravate eczema. Excessive heat (especially with humidity) and coldness are known to provoke outbreaks, as well as sudden and extreme temperature swings.
The Scratch Test: An allergy skin-patch or "scratch" test, given by an allergist, can often pinpoint the triggers of allergic reactions. Once the causes of the allergic reactions are discovered, the allergens should be eliminated from the diet, lifestyle, and/or environment. If the eczema is severe, it may take some time (days to weeks depending on the severity) for the body's immune system to begin to settle down after the irritants are withdrawn.
The primary treatment involves prevention, includes avoiding or minimizing contact with (or intake of) known allergens. Once that has been established, topical treatments can be used. Topical treatments focus on reducing both the dryness and inflammation of the skin.
To combat the severe dryness associated with eczema, a high-quality, dermatologist approved moisturizer should be used daily. Moisturizers should not have any ingredients that may further aggravate the condition. Moisturizers are especially effective if applied within 5–10 minutes after bathing. A doctor might also prescribe lotion containing sodium hyaluronate to improve skin dryness
Most commercial soaps wash away all the oils produced by the skin that normally serve to prevent drying. Using a soap substitute such as aqueous cream helps keep the skin moisturized. A non-soap cleanser can be purchased usually at a local drug store. Showers should be kept short and at a lukewarm/moderate temperature.
If moisturizers on their own don't help and the eczema is severe, a doctor may prescribe topical corticosteroid ointments, creams, or injections. Corticosteroids have traditionally been considered the most effective method of treating severe eczema.
Disadvantages of using steroid creams include stretch marks and thinning of the skin. Higher-potency steroid creams must not be used on the face or other areas where the skin is naturally thin; usually a lower-potency steroid is prescribed for sensitive areas. If the eczema is especially severe, a doctor may prescribe prednisone or administer a shot of cortisone or triamcinolone If complications include infections (often of Staphylococcus aureus), antibiotics may be employed.
A more novel form of treatment involves exposure to broad or narrow-band ultraviolet light. UV radiation exposure has been found to have a localized immunomodulatory effect on affected tissues, and may be used to decrease the severity and frequency of flares. The usage of UVA1 is more effective in treating acute flares, whereas narrow-band UVB is more effective in long-term management scenarios.However, UV radiation has also been implicated in various types of skin cancer,and thus UV treatment is not without risk.
Lifestyle and home remedies To help reduce itching and soothe inflamed skin, try these self-care measures: Try to identify and avoid triggers that worsen the inflammation. Rapid changes of temperature, sweating and stress can worsen the condition. Avoid direct contact with wool products, such as rugs, bedding and clothes, as well as harsh soaps and detergents.
Lifestyle and home remedies Apply an anti-itch cream or calamine lotion to the affected area. A nonprescription hydrocortisone cream, containing at least 1 percent hydrocortisone, can temporarily relieve the itch. A nonprescription oral antihistamine, such as diphenhydramine (Benadryl, others), may be helpful if itching is severe. Avoid scratching whenever possible. Cover the itchy area if you can't keep from scratching it. Trim nails and wear gloves at night.
Lifestyle and home remedies Apply cool, wet compresses. Covering the affected area with bandages and dressings can help protect the skin and prevent scratching. Take a warm bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for the bathtub (Aveeno, others). Or, add 1/2 cup (118 milliliters) of bleach to a 40 gallon (151 liter) bathtub filled with warm water. The diluted bleach bath is thought to kill bacteria that grow on the skin.
Lifestyle and home remedies Choose mild soaps without dyes or perfumes. Be sure to rinse the soap completely off your body. Moisturize your skin. Use an oil or cream to seal in moisture while your skin is still damp from a bath or shower. Pay special attention to your legs, arms, back and the sides of your body. If your skin is already dry, consider using a lubricating cream. Wear cool, smooth-textured cotton clothing. Avoid clothing that's rough, tight, scratchy or made from wool. This will help you avoid irritation. Also, wear appropriate clothing in hot weather or during exercise to prevent excessive sweating.
Factors that worsen atopic dermatitis Long, hot baths or showersDry skinStressSweatingRapid changes in temperatureLow humiditySolvents, cleaners, soaps or detergentsWool or man-made fabrics or clothingDust or sand
Atopic Dermatitis At A Glance Atopic dermatitis is a type of eczema. The skin sensitivity of this disease may be inherited and genetically determined. The patient's skin may be "super sensitive" to many irritants. Dry scaly patches develop in a characteristic distribution. Itching varies but may be intense and scratching hard to resist. Scratching can cause skin thickening and darkening and lead to further complications, including bacterial infection.
Atopic Dermatitis At A Glance Extremely dry skin can break down and ooze or weep. If the itch can be controlled, the rash (which is aggravated by vigorous scratching) may be more readily contained. Treatment of atopic dermatitis is centered around rehydrating the skin with rich moisturizers like Vaseline and cautious use of topical steroids to reduce inflammation and itching. Oral antihistamines are often necessary to break the "itch-scratch" cycle. Since secondary infections can aggravate the rash, topical or oral antibiotics may also be occasionally indicated.
Researchers have discovered a very effective and low-tech means of managing eczema. It’s called household bleach. The bleach study, published in the journal Pediatrics, found that giving diluted bleach baths to children with moderate or severe eczema (atopic dermatitis) reduced signs of infection and reduced the severity and extent of the eczema on their bodies. Dr. Amy Paller and researchers treated 31 patients (6 months to 17 years old) who had eczema and a bacterial staph infection for 14 days with oral antibiotics. Half of the patients received bleach in their bath water (half a cup per full standard tub), while the other half received a look-alike placebo. All were instructed to bathe in the bleach twice a week, and soak for five to 10 minutes for three months.
The research team saw such rapid improvement in the kids taking the real bleach baths that they terminated the study early because they wanted the children getting the placebo to get the same relief. "The eczema kept getting better and better with the bleach baths and these baths prevented it from flaring again," Paller said. "We presume the bleach has antibacterial properties and decreased the number of bacteria on the skin, which is one of the drivers of flares."
