Atopic dermatitis

Atopic dermatitis (AD), also known as eczema, is the most common type of persistent, inflammatory skin disorder. AD is an allergic reaction that causes itchy, dry, and scaly skin. The symptoms may come and go throughout life or may resolve itself by the end of childhood.

Last Updated: February 21, 2024

Ten to thirty percent of children and two to ten percent of adults in industrialized nations suffer from atopic dermatitis. The incidence of this condition has increased by a factor of two to three in the last few decades. People in higher latitudes have a greater frequency of atopic dermatitis, which may be related to less sun exposure and lower humidity in these areas.

 

Atopic dermatitis is caused by more than one factor. It happens when the barrier function of the skin is broken. As a result, it makes the skin more sensitive and open to damage from irritants and allergens in the environment. 

 Allergens come in different forms like smoke, dust, and food. Some of the most common food allergens are peanuts, tree nuts, eggs, soy, cow's milk, wheat, shellfish, and seafood.

Some common signs of atopic dermatitis are:

  • Dry skin
  • Itching
  • Swelling and inflammation (skin turns red)
  • Rashes that can be red, brown, purple, or gray
  • Small bumps or crusts that are filled with fluid
  • Cracked skin

 

In children and adults, atopic dermatitis usually happens in places where the skin bends or flexes, like behind the knees or on the inside of the elbow. In newborns and infants, it occurs more on the face and skin areas that extend rather than flex.  

Atopic dermatitis is usually diagnosed by inspecting how the skin lesions appear in each age group. Doctors may also perform a skin prick test to confirm the diagnosis and determine what allergens trigger the reaction.

 

Sometimes doctors order a biopsy which will show a pattern that indicated eczema while fluorescent enzyme immunoassays can be used to find immunoglobulin E (IgE) antibodies against specific allergens in children who don't respond to treatment. These antibodies may or may not be a clinically important aggravating factor.

 

 

Treatment

The four main parts of treatment are avoiding triggers, taking care of the skin every day, using anti-inflammatory therapy, and using other complementary methods.

 

Emollient type moisturizers should be used twice daily, within three minutes of getting out of a lukewarm shower or bath, to keep the skin from drying. When there are acute flares, topical steroids should be applied before emollients can "lock in" their impact.

 

Doctors may also advise tacrolimus and pimecrolimus for sensitive areas such as the face, axilla, and groin. Systemic therapies for uncontrolled atopic dermatitis include phototherapy (UVA, UVB, and narrow-band UVB), cyclosporine, azathioprine, mycophenolate mofetil, and methotrexate.

 

Inflammation therapy includes dupilumab, a monoclonal antibody treatment. 

 

Probiotics are also used because they have the potential to help certain individuals since it is thought that these live bacterial products can boost the immune system and stop the formation of an allergic IgE antibody reaction.

To relieve itching and inflammation:

  • Moisturize the skin twice daily by using fragrance-free lotions, oils, sprays, and ointments
  • Use anti-itch creams such as OTC hydrocortisone cream as these can briefly relieve atopic dermatitis irritation
  • Do not scratch the skin instead, press it to relieve the itchiness
  • Dress comfortably and do not use itchy, tight clothing
  • If possible, use a humidifier since dry indoor air might aggravate atopic dermatitis
  • Mindfulness, meditation, and relaxation can help manage atopic dermatitis symptoms caused by stress and worry

 

References

Ingold CJ, Khan MAB. Pemphigus Vulgaris. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560860/

Oakley, A., Shakeel, M (2022). Pemphigus vulgaris. Retrieved January 14, 2023, from https://dermnetnz.org/topics/ pemphigus-vulgaris

 

Cleveland Clinic (2023). Pemphigus. Retrieved January 14, 2023, from https://my.clevelandclinic.org/health/diseases/21130-pemphigus

Last Updated: February 21, 2024