What is Atopic Dermatitis?
Atopic dermatitis or eczema is a chronic inflammatory condition of the skin in children and adults.
The disease is characterized by itch, rash and frequent skin infections.
It precedes the development of the allergic rhinitis and asthma.
How prevalent is AD in children?
Incidence–>10 % children are affected.
How the AD rashes are distributed?
Atopic dermatitis rashes have distributed differently in infants,children,adolesence and adults.In younger kids it can come anywhere in the body, in early childhood these rashes are distributed on flexural areas (elbows, behind the knees, front of ankle or around the neck), neck, dorsal aspect of limbs. In adult and adolescence lesions are found in head and neck region and flexural surface. Thick and dark skin is seen over the lesion.
Common sites of eczema outbreaks in Adult,children & infants
What are the causes of Eczema?
Is this disease has genetic links?
It is inherited in the form of complex multiple genes. If both parents are affected there are 80% chance that child will develop atopic dermatitis.
If one parent is suffering from atopic dermatitis and other is suffering from respiratory allergies there are 61 % chance of developing Atopic dermatitis in children.
If one parent is atopic =50% chance child is having AD
What are the clinical features of Atopic Dermatitis?
Acute lesions are intensely pruritic Signs and symptoms of atopic dermatitis (eczema) include:
- Red to brownish-gray colored patches
- Itching, which may be severe, especially at night
- Small, raised bumps, which may leak fluid and crust over when scratched
- Thickened, cracked or scaly skin
- Raw, sensitive skin from scratching
Course of the disease
Atopic dermatitis most often begins in childhood before age 5 and may persist into adulthood. For some, it flares periodically and then subsides for a time, even up to several years. Itching may be severe, and scratching the rash can make it even itchier and cause more inflammation. Once the skin barrier is broken, the skin can become infected by bacteria, especially Staphylococcus aureus, which commonly live on the skin. Breaking this itch-scratch cycle can be challenging.
What are the types of Eczema (Dermatitis) ?
- Allergic contact eczema (dermatitis). A red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions.
- Atopic dermatitis. A chronic skin disease characterized by itchy, inflamed skin.
- Contact eczema. A localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (an allergy-causing substance) or with an irritant such as an acid, a cleaning agent, or other chemical.
- Dyshidrotic eczema. Irritation of the skin on the palms of the hands and soles of the feet characterized by clear, deep blisters that itch and burn.
- Neurodermatitis. Scaly patches of the skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite) that become intensely irritated when scratched.
- Nummular eczema. Coin-shaped patches of irritated skin—most common on the arms, back, buttocks, and lower legs—that may be crusted, scaling, and extremely itchy.
- Seborrheic eczema. Yellowish, oily, scaly
- Stasis dermatitis. A skin irritation on the lower legs, generally related to circulatory problems
What are the Factors that worsen Atopic Dermatitis?
Infections- Most people with atopic dermatitis also have Staphylococcus aureus bacteria on their skin. The staph bacteria multiply rapidly when the skin barrier is broken and fluid is present on the skin, which in turn may worsen symptoms, particularly in young children.
Other factors that can worsen signs and symptoms of atopic dermatitis include:
- Dry skin
- Long, hot baths or showers
- Rapid changes in temperature
- Low humidity
- Solvents, cleaners, soaps or detergents
- Wool or man-made fabrics or clothing
- Dust or sand
- Cigarette smoke
- Living in cities where pollution is high
- Certain foods, such as eggs, milk, fish, soy or wheat
When to see an Allergist?
See your Allergist if:
You’re so uncomfortable that you’re losing sleep or are distracted from your daily routines
- Your skin is painful
- You suspect your skin is infected
- You’ve tried self-care steps without success
If you suspect your child has Atopic Dermatitis or you notice the above signs and symptoms, see your child’s doctor.
Early, effective treatment helps keep atopic dermatitis from worsening. The more severe it becomes, the more difficult it is to control.
Complications of Atopic Dermatitis (Eczema) include:
- Neurodermatitis. Prolonged itching and scratching may increase the intensity of the itch, possibly leading to neurodermatitis (lichen simplex chronicus). Neurodermatitis is a condition in which an area of skin that’s frequently scratched becomes thick and leathery. The patches can be raw, red or darker than the rest of your skin. Persistent scratching can also lead to permanent scars or changes in skin color.
- Skin infections. Sometimes, scratching can break the skin and cause open sores and fissures that can become infected, a process called impetiginisation. A milder form of infection is impetigo, usually due to staphylococcal infection. Having atopic dermatitis predisposes you to this infection.
- Eye complications. Severe atopic dermatitis can also cause eye complications, which may lead to permanent eye damage. When these complications occur, itching in and around the eyelids becomes severe. Signs and symptoms of eye complications also include eye watering and inflammation of the eyelid (blepharitis) and the lining of the eyelid (conjunctivitis). If you suspect complications with your eyes, see your doctor promptly.
SCORAD is a clinical tool used to assess the extent and severity of eczema (SCORing Atopic Dermatitis). Dermatologists may use this tool before and after treatment to determine whether the treatment has been effective.
To determine extent, the sites affected by eczema are shaded on a drawing of a body. The rule of 9 is used to calculate the affected area (A) as a percentage of the whole body.
- Head and neck 9%
- Upper limbs 9% each
- Lower limbs 18% each
- Anterior trunk 18%
- Back 18%
- 1% for genitals.
The score for each area is added up. The total area is ‘A’, which has a possible maximum of 100%.
A representative area of eczema is selected. In this area, the intensity of each of the following signs is assessed as none (0), mild (1), moderate (2) or severe (3).
Kindly refer the picture given below to rate your intensity.
- Oozing / crusting
- Scratch marks
- Skin thickening (lichenification)
- Dryness (this is assessed in an area where there is no inflammation)
The intensity scores are added together to give ‘B’ (maximum 18).
Atopic dermatitis: intensity scoring
Subjective symptoms i.e., itch and sleeplessness, are each scored by the patient or relative using a visual analogue scale where 0 is no itch (or no sleeplessness) and 10 is the worst imaginable itch (or sleeplessness). These scores are added to give ‘C’ (maximum 20).
The SCORAD for that individual is A/5 + 7B/2 + C
Treatment of Atopic Dermatitis
- Avoidance of irritant & specific triggersAvoidance of allergen
- Complete avoidance of soap and detergent
- Avoid swimming in chemically treated pools
- Avoid extreme temperature and humidity
- Prefer non abrasive and breathable texture fabrics
- Avoid occlusive clothing
- Food allergens: milk, egg, peanuts, soy, wheat, and fish. Avoid implicated food completely
- Repair and maintenance of skin barrier
- Moisturizers-emollient + hydration therapy restores and preserve the skin barrier.
- Interruption of itch scratch cycle-systemic antihistamines and anxiolytics are helpful
- Reduction of inflammation
THE ATOPIC MARCH
Incidence of other allergic conditions in patients suffering from AD
Incidence of Allergic rhinitis increases from 3 to 15% in atopic dermatitis patients.
Incidence of Asthma increase from 5 to 40% in patients suffering from atopic dermatitis.
Severity of AD and risk of development of asthma
Normal subjects (without AD) 8%
Mild AD 20%