Atopic dermatitis, a topic of pediatric dermatology is my next blog. It affects 5-15% of school children and 2-10% of adults. What makes it worth to write a blog is, since it majorly affects children and makes the child have good and bad days throughout the childhood, the entire family has its peaks and valleys, that too for a long time. So, when you have to be up against something for that long, then it is important to understand what you are against, to try and have it under control.
Is eczema and atopic dermatitis the same?
Eczema refers to a group of conditions that cause inflamed skin. There are many types of eczema. Atopic dermatitis is the most common type.
What is Atopic dermatitis?
Atopic dermatitis also known as atopic eczema is a chronic skin inflammatory condition. ‘Atopy’ means hyper reactive immune system, and dermatitis means inflammation of the skin. It is what we know as the sensitive skin. Though it commonly affects children, it can occur at any age. Usually starts in infancy and as the child grows, it might get better.
Why does atopic dermatitis occur?
The exact cause of atopic dermatitis is unknown. The condition often runs in families and may also be triggered by several environmental factors. Environmental factors that can trigger are
(a) physical factors like sweating, climate, warm surroundings, detergents and soap, synthetic or woollen fabrics, cigarette smoke,
(b) psychological factors,
(c) food items (including tomato, orange and citrus fruits, juice from meat, fish)
(d) allergens such as house dust mite, animal hair, pollen, plants and
(e) Others such as Staphylococcus aureus and release of exotoxins (superantigens) and saliva in small children
Persons with atopic dermatitis may have other immunological disorders like hay fever and asthma.
There are 2 theories postulated to explain how it occurs.
- Increased sensitivity of Ig E Inflammation of skin cells skin barrier disruption
- Skin barrier disruption increased Ig E inflammation of skin cells
How is it diagnosed?
Since there is no one thing that can make a definitive diagnosis, usually it is diagnosed based on fulfilment of criterias. There are many named criterias for diagnosis but the one commonly used is Hanifin and Rajka criteria.
Whatever may be the criteria, one thing that is necessary to diagnose atopic dermatitis is itchy rash with typical distribution which occurs on and off.
General myths and facts about Atopic eczema:
Myth:
You can get rid of AD by finding and eliminating the one thing causing it. When speaking with parents who have a child with eczema, dermatologists often find that parents want help finding that one food or another allergen causing their child’s eczema. Before seeing a dermatologist, parents often say that they have already experimented with removing different foods from their child’s diet, such as eggs, milk, and nuts.
Fact:
Years of research has proven that no one thing causes AD. It’s a complex disease that has no cure.
Removing foods from a child’s diet cannot cure AD, but it can cause health problems. Children need the nutrients in foods, such as eggs and milk, to grow and develop properly.
Myth:
Children outgrow AD. Although it’s true that AD often goes away on its own before a child’s 18th birthday, AD can be a lifelong condition.
Fact:
There’s no way to know if a child’s eczema will go away or remain. To prevent AD from worsening and to relieve symptoms, dermatologists recommend treating it.
Myth:
To reduce flare-ups, cut back on bathing. Because AD causes extremely dry skin, some people believe they can relieve AD by taking fewer baths and showers. Research shows otherwise.
Fact:
Taking a short, daily lukewarm bath or shower helps. Bathing removes bacteria and other germs from the skin, which can reduce skin infections. Many people with AD get skin infections.
Applying a fragrance-free moisturizer to the skin within a few minutes of bathing helps to lock moisture into the skin and reduce dryness.
How is Atopic dermatitis treated?
There is no single cure for atopic dermatitis. However, there are several measures and medications that may help relieve the symptoms of the condition and prevent flare ups of atopic dermatitis.
Many infants and children with atopic dermatitis may find that their symptoms ease as they grow into adulthood. There are several preventive measures such as avoidance of the known triggers, keeping skin moist and preventing scratching that can reduce the frequency and severity of atopic dermatitis flare ups.
Main treatment regimen will consist of,
- Emollients or moisturizers:
We already saw how skin barrier is disrupted in atopic dermatitis. Hence use of liberal and frequent use of good quality moisturisers play a very vital role in preventing flare ups and calms the flares. Ointments are suitable for very dry skin while a cream or lotion is for less dry skin. Emollients for face and hands are different for those used over the body. Emollients may also be added to bath water.
- Corticosteroids:
Corticosteroids are used over skin as ointments, lotions or creams. Corticosteroids work by reducing skin inflammation. Over long term use they may cause thinning of the skin, visible blood vessels underneath, increased hair growth and acne.
- Wet wrap therapy:
Wet wrap therapy is a treatment where you put wet dressings to your skin to rehydrate and soothe it. First, you soak gauze or fabric in warm water. Then, you put it on the affected areas of your skin. You’ll cover it with a layer of dry cloth and leave it there usually for a few hours or overnight. Typically, the wet dressing will be placed over any topical product that has already been applied to the area. The topical product can be bland emollient or mild topical steroid.
- Immunological suppressors
Immunological suppressors like pimecrolimus and tacrolimus are prescribed in severe cases. They suppress the local immunity and prevent allergic reactions leading to flare ups.
- Antihistamine medications
Antihistamine medications are prescribed to relieve itching. There are different family of antihistamines and they will be prescribed according to severity and the age of the patient.
- Oral corticosteroids
In severe flare ups when topical or locally applied corticosteroids fail to provide relief oral corticosteroids may be added. Once this is added, it is very important that you make your review visits strictly as suggested by the dermatologist.
- Less used agents include, Interleukin inhibitors, JAK inhibitors, PDE 4 inhibitors and phototherapy.
To summarise, I know it is a lot to process, but when it comes to children we are bound to give them the best. There are many support groups to help the parents to keep them updated and motivated. Atopic dermatitis though may look angry and worrying, with proper treatment and good maintanence our eczema child can have a great and large funfilled childhood.