Atopic Dermatitis (Atopic Eczema): Symptoms, Diagnosis and Treatment
Atopic dermatitis is a chronic (long-term) skin disease that causes inflammation and itching. Usually, this disease is found in infants or young adults but can also occur in adults. The disease is generally caused by an increased level of immunoglobulins (IgE). Atopic dermatitis can be further triggered by some allergens including dust mites, pollens, soaps, etc. Severe cases of atopic dermatitis can affect the quality of life.
Atopic dermatitis is not always appeared due to immunological reactions; it may also develop due to other allergic diseases, e.g., allergic rhinitis or asthma (60%) and food allergies (30%). The development of diseases together follows a sequence Atopic March. In the beginning, atopic dermatitis develops followed by allergic rhinitis and finally, asthma.
In patients with atopic dermatitis, there is an increased risk of developing other inflammatory diseases including rheumatoid arthritis and inflammatory bowel disease, and hair loss due to immune system responses. In some individuals with atopic dermatitis, the immune system fails to defend against foreign substances, and the individuals become prone to infections.
Symptoms of Atopic Dermatitis
In infants, the yellowish desquamation on the scalp known as cradle cap may be the sign of eczema.
Atopic dermatitis may spread to the face, arms, and legs, sometimes cause crusting and oozing. Further, the disease may spread to hands and neck, and causes dry skin and increased water loss “from the skin. Scratching and rubbing of the skin lead to the formation of thick and leathery patches on the skin.
People affected with atopic dermatitis may have periods with few symptoms or periods with severe symptoms.
Diagnosis of Atopic Dermatitis
- The affected individual is asked for the use of products that trigger the allergy.
- A diluted allergen is applied in the skin with a puncture or prick. The tested area is observed for 15 minutes for the development of a bump or redness. The allergen is applied on the back or forearms in adults and on back in children.
- Approximately 30%-60% of children with atopic eczema have food allergies. Therefore, children under five are evaluated for the egg, milk, peanut, soy, and wheat allergies. If anyone of these is found to be the cause of the allergy, then that food is eliminated from the diet.
Management and Treatment of Atopic Dermatitis
- Antihistamine and/or topical steroids are recommended for atopic dermatitis. In case of mild symptoms, moisturizers and petroleum jelly may be used on a regular basis to treat dryness.
- Mild soaps, shampoos and other products with minimum or no chemicals should be used. Rehydration is necessary, so water should be consumed in adequate amount.
- The affected person should avoid contact with allergens. Masks and gloves should be used.
- To avoid itching in infants after bathing, moisturizer should be applied immediately. Limited use of pH balanced skin cleansers is advised in the frequent bathing. To seal in the moisture, gentle patting dry and immediate application of moisturizer after bath is advised. This technique is called “soak and smear” technique.
- In 2016, a drug crisaborole was approved for mild or moderate atopic dermatitis in adults and children (more than 2 years). It is also safe for long-term use. Another drug dupilumab (twice-monthly injection) was approved in 2017 by the FDA to treat patients (18 years of age and older) with the severe form of the disease.
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