Atopic dermatitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 22, 2016
StartDiseasesAtopic dermatitis

Atopic dermatitis is a skin condition that roughly 20% of the population experiences at some point in their lives. It is sometimes referred to as eczema, a medical term that describes a variety of skin conditions. While this inflammation of the skin can be uncomfortable or unpleasant, there are fortunately ways to decrease the severity of the disorder.

Contents

Definition & Facts

Atopic dermatitis is inflammation of the skin that occurs over a long period of time. It is often confused with other skin conditions, but atopic dermatitis results in itchy, swollen, red skin that cracks and leaks clear fluid. Atopic dermatitis commonly occurs among babies and children, and it typically gets better with age. However, it can happen to anyone during any period of their lives.

The symptoms of atopic dermatitis tends to occur in patterns; they will be very bad during flares and then clear up during a remission period. Flares often occur because a person has been exposed to allergens or other irritants.

Symptoms & Complaints

People who have atopic dermatitis often have skin that is generally dry, scaly, and itchy. They also develop patches of skin, called lesions, that are raised, reddish, itchy areas. When the sensitive lesions are irritated by things such as scratching or movement, they can crack, swell, crust over, and leak thick, clear fluid. When the skin is broken by these lesions and cracks, a person is particularly vulnerable to infections by the staphylococcus aureus bacteria.

The areas of skin affected by this particular type of eczema tend to shift as people age. Infants, who most commonly have the condition, tend to have facial lesions with small patches of atopic dermatitis in other areas. Children typically have more lesions where limbs bend, such as the fronts of the elbows, back of the knees, wrists, and ankles.

As people age, the lesions may clear up, or they might persist near flexure points, but they most commonly happen on hands and feet. A person can go years without any flares and then experience the most severe atopic dermatitis symptoms again. A variety of issues may cause the symptoms of this type of eczema to worsen.

Causes

The precise cause of atopic dermatitis is unknown, but several different factors affect the likelihood of a person developing eczema. Some statistics point to a possible genetic cause; if one identical twin has atopic eczema, the other one is 85% likely to have it too. Mutations in the gene that produces filaggrin seem to be partially responsible for atopic dermatitis.

Researchers theorize that a dysfunctional immune system somehow ends up harming the skin while it is trying to fight off allergies. Certain environmental factors such as chemicals or dry weather, also make a person more likely to get atopic dermatitis. Individual flares are mostly triggered by irritants that a person is exposed to. Triggers for flare ups include:

  • Dry skin
  • Hot showers
  • Stress
  • Scratching
  • Sweating
  • Bacteria or viruses
  • Detergents, soaps, and cleaners
  • Wool clothing or bedding
  • Air pollution and tobacco smoke
  • Dust or pollen
  • Milk, eggs, peanuts, fish, wheat, and soybeans

Diagnosis & Tests

In order to diagnose atopic dermatitis, the health care professional must rule out other skin conditions. Since there are many other conditions that can cause itchy, red, scaly skin, it is important for a doctor to make sure that there is not any sort of underlying cause for the atopic dermatitis. The doctor may send skin biopsies and skin swabs to a lab to rule out staphylococcal infections, contact dermatitis, psoriasis, and seborrheic dermatitis.

After atopic dermatitis is diagnosed, tests may be helpful in determining which triggers are causing flares. During a patch test, a doctor will prick or scratch the skin, typically along the upper back area, and expose it to a variety of potential allergens. After a few days, the skin is examined to see what areas are agitated by the potential triggers. The most common allergens that a skin patch test reveal are nickel sulfate and perfume fragrances.

Treatment & Therapy

There is no specific treatment for atopic dermatitis, but there are many treatment options that can lessen the likelihood of flares and soothe uncomfortable symptoms. Corticosteroid creams, corticosteroid injections, or oral corticosteroids can help to manage the itchiness and severe inflammation. It is very important to lessen the itchiness, since scratching can worsen the atopic dermatitis, so oral antihistamines can also be helpful when a person is suffering from a particularly itchy flare.

Certain types of calcineurin inhibitors, such as pimecrolimus tacrolimus, help to lessen the immune response when exposed to allergens, preventing flares from occurring in the first place. Some unconventional forms of therapy, including soaking in salt water and wearing silver-coated clothing have been shown to possibly reduce both the frequency and severity of flares, but their precise effects have not been studied.

Light therapy, in the form of sitting in the sunlight or being near an artificial source of ultraviolet light, helps to make flares less severe, and taking vitamin D supplements also is useful when managing atopic dermatitis.

Prevention & Prophylaxis

Lifestyle changes can prevent severe lesions and flares from developing. These changes include eating a healthy diet, not wearing wool clothing, and avoiding dry climates. Any allergens which have been determined to cause flares should be avoided as much as possible.

Baths and showers should always be mild, instead of scalding hot. It is also important to stay in a clean environment and regularly wash clothes and bedding, since dust and dust mites may cause an atopic dermatitis flare.