Eczema
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.
The disease is characterized by itch, rash and frequent skin infections.
How prevalent is AD in children?
Incidence–>10 % children are affected.
What are the clinical features of Atopic Dermatitis?
Rashes
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
Distribution of rashes
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.
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 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 types of Eczema (Dermatitis) ?
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:
1
Dry skin
3
Stress
5
Rapid changes in temperature
7
Solvents, cleaners, soaps or detergents
9
Dust or sand
11
Living in cities where pollution is high
2
Long, hot baths or showers
4
Sweating
6
Low humidity
8
Wool or man-made fabrics or clothing
10
Cigarette smoke
12
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.
How atopic dermatitis is treated?
Avoidance of irritant & specific triggersAvoidance of allergen
Avoid swimming in chemically treated pools
Avoid extreme temperature and humidity
Avoid extreme temperature and humidity
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
1
Normal subjects (without AD) 8%
2
Mild AD 20%
3
Severe 70%
