Atopic Dermatitis
Ira Shah
Consultant Pediatrician, Nanavati Hospital, Mumbai, India
First Created: 01/17/2001 

Introduction

What is atopic dermatitis?

Atopic dermatitis is a chronic, recurrent, itchy skin condition that is due to skin inflammation. It is seen more commonly in individuals with a personal or a family history of allergies such as those having asthma, hay fever, allergic rhinitis, or other allergies. It is commonly considered as eczema though eczema is dermatitis that can represent a variety of skin conditions.

How common is atopic dermatitis?

Atopic dermatitis affects almost 1-2 out of every 10 children worldwide.

What is the age when atopic dermatitis commonly occurs?

Atopic dermatitis commonly begins in infancy or early childhood. Approximately 60% of patients with this condition develop it before their 1st birthday and around 30% present between 1-5 years of age. The disease is characterized by intermittent acute flares.

What are the causes for atopic dermatitis?

There is a strong genetic tendency in atopic dermatitis with 30-70% of patients having a family history of allergies. In addition, exposure to certain environmental factors can provoke atopic dermatitis.

What are the provoking factors of atopic dermatitis?

Excessive drying of the skin, excessive sweating, irritants (soaps, detergents, perfumes, woolen clothing), certain types of food, inhalant allergens, dust mites can all exacerbate itching in predisposed individuals

What the symptoms of atopic dermatitis?

Children with atopic dermatitis tend to have dry, lustreless skin. Lesions tend to be very itchy and it is worse in the night. The skin appears red and inflamed. Scratching can lead to splitting of the skin which may then start oozing and become secondarily infected. Overtime skin areas that are affected become dark and thick. In children, common areas affected are cheeks, forehead, scalp, neck, and limbs especially the back of elbow and back of knees.

How is Diagnosis of Atopic Dermatitis Made?

The diagnosis is generally made clinically. There are no laboratory tests for confirmation. Patients with the disease may have increased eosinophil count and increased blood IgE levels. Patch testing can help differentiate atopic dermatitis from contact dermatitis.

What is the treatment of atopic dermatitis?

Treatment of atopic dermatitis consists of avoiding precipitating factors, hydrating the skin, preventing scratching of skin, and drugs that control atopic dermatitis.

Avoid excessive use of soap. Use cotton clothing. Avoid perfumes and scented soaps, washing powders, and fabric softeners. Choose a soap that has an oil or fat base. Avoid extremes of temperature and excessive sweating. Use emollients and moisturizers.

Treatment of atopic dermatitis consists of drugs that control itching and steroid creams. Antihistamines are commonly used if the itching is severe and even at night. Steroid creams should be used sparingly and in low concentration.

In case of severe atopic dermatitis where steroids are not working, other drugs that are used are Pimecrolimus, coal tar (Tar shampoo can be used for scalp involvement), cyclosporine, and steroid syrups or tablets (used only for short term and for acute flare). Children who receive pimecrolimus are predisposed to sun-induced damage so adequate sun protection and sunscreen should be used. Phototherapy with ultraviolet B (UVB) can be used for severe resistant cases.


Atopic Dermatitis Atopic Dermatitis 01/17/2001
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