Atopic Dermatitis
Atopic dermatitis is a common, often persistent skin disease that affects a large percentage of the world’s population. The condition rarely starts before 4–6 weeks of age and usually begins between the ages of 2 and 3 months. Atopic dermatitis is a special type of allergic hypersensitivity that is associated with asthma, inhalant allergies (hay fever), and a chronic dermatitis. There is a known hereditary component of the disease, and it is more common in affected families. Criteria that enable to analyze it include the typical appearance and distribution of the rash in a patient with a personal or family history of asthma and/or hay fever.
The term atopic is from the Greek meaning strange. The term dermatitis means inflammation of the skin. Many physicians and patients use the term eczema when they are referring to this condition. Sometimes it is called neuro-dermatitis. Atopic dermatitis (eczema) is a condition that makes skin red and itchy. But when it long-lasting, red, itchy rashes, could be atopic dermatitis. Some major and some minor feature are:
Major features
- Itching
- Characteristic rash in locations typical of the disease (arm folds and behind knees)
- Chronic or repeatedly occurring symptoms
- Personal or family history of atopic disorders (eczema, hay fever, asthma)
Some minor features
- Early age of onset
- Dry, rough skin
- High levels of immunoglobulin E (IgE), an antibody, in the blood
- Ichthyosis
- Hyper linear palms
- Keratosis pilaris
- Hand or foot dermatitis
- Cheilitis (dry or irritated lips)
- Nipple eczema
- Susceptibility to Skin infection
- Positive allergy skin tests
Although atopic dermatitis can occur in any age, most often it affects infants and young children. Occasionally, it may persist into adulthood or may rarely appear at that time. Some patients tend to have a protracted course with ups and downs. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, which are followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis enter into a permanent remission of the disease when they get older, although their skin may remain somewhat dry and easily irritated.
Although symptoms and signs may vary from person to person, the most common symptoms are dry, itchy, red skin. Itch is the hallmark of the disease. Typically, affected skin areas include the folds of the arms, the back of the knees, wrists, face, and neck.
The itchiness is an important factor in atopic dermatitis, because scratching and rubbing can worsen the skin inflammation that is characteristic of this disease. People with atopic dermatitis seem to be more sensitive to itching and feel the need to scratch longer in response. They develop what is referred to as the itch-scratch cycle. The extreme itchiness of the skin causes the person to scratch, which in turn worsens the itch, and so on. Itching is particularly a problem during sleep, when conscious control of scratching decreases and the absence of other outside stimuli makes the itchiness more noticeable.
The cause of atopic dermatitis is not known, but the disease seems to result from a combination of genetic (hereditary) and environmental factors. There seems to be a basic cutaneous hypersensitivity and an increased tendency toward itching. Evidence suggests that the disease is associated with other so-called atopic disorders such as hay fever and asthma, which many people with atopic dermatitis also have. Many children, who outgrow the symptoms of atopic dermatitis, develop hay fever or asthma. Although one disorder does not necessarily cause another, they may be related, thereby giving researchers clues to understanding atopic dermatitis. Many of those affected seem to have either a decreased quantity of or a defective form of a protein in their skin. This protein seems to be important in maintaining normal cutaneous hydration. It is important to understand that food sensitivities do not seem to be a major inciting factor for most cases of atopic dermatitis.
Patients with atopic dermatitis seem to have mild immune system weakness. They are predisposed to develop fungal foot disease and cutaneous staphylococcal infections. They can disseminate herpes simplex lip infections (eczema herpeticum) and smallpox vaccination (eczema vaccinatum) to large areas of skin.
While emotional factors and stress may sometimes exacerbate the condition, they do not seem to be a primary or underlying cause for the disorder.
Trigger factors:
Some things that trigger atopic dermatitis or make it worse include:
- Strong soaps and detergents
- Some fabrics, like wool or scratchy materials
- Perfumes, skin care products, and makeup
- Pollen and mold
- Animal dander
- Tobacco smoke
- Stress and anger
- Dry winter air/low humidity
- Long or hot showers/baths
- Dry skin
- Sweating
- Dust or sand
- Certain foods (usually eggs, dairy products, wheat, soy, and nuts)
If the disease does not respond to mild treatment then a physician advice is required. With proper treatment, most symptoms can be brought under control within three weeks.
Corticosteroid creams and ointments are the most frequently used for treatment. Since many of these are quite potent it will be necessary to have frequent physician visits to assure that the treatment is successful.
Tacrolimus and pimecrolimus are non-steroid topical ointments that contain molecules that inhibit a substance called calcineurin which is important in inflammation. They are used for the treatment of atopic dermatitis. They are particularly effective in when used on the faces of children since they seem less likely to produce atrophy. It is used as a immune modulators.
Crisaborole is a topical treatment for children and adults. Mild to moderate atopic dermatitis is seems to work by inhibiting a different portion of the inflammatory cascade in skin.
Dupilumab is a treatment of moderate to severe atopic dermatitis in adults. It is an anti-IL-4 antibody that is given by injection twice a month and shows great promise in the control of severe atopic dermatitis.
Atopiclair, MimyX, and CeraVe is repair and improve the skin’s barrier function in both children and adults. These creams may be used in combination with topical steroids and other emollients to help repair the overall dryness and broken skin function.
Additional available treatments may help to reduce specific symptoms of the disease. Oral antibiotics to treat staphylococcal skin infections can be helpful in the face of pyoderma. Certain antihistamines that cause drowsiness can reduce night time scratching and allow more restful sleep when taken at bedtime. This effect can be particularly helpful for patients whose night time scratching aggravates the disease. If viral or fungal infections are present, need medications to treat those infections.
Phototherapy is treatment with light that uses ultraviolet A or B light waves or a combination of both. This treatment can be an effective treatment for mild to moderate dermatitis in older children (over 12 years old) and adults. Photochemotherapy, a combination of ultraviolet light therapy and a drug called psoralen, can also be used in cases that are resistant to phototherapy alone. Possible long-term side effects of this treatment include premature skin aging and skin cancer. Phototherapy may be useful in treating the symptoms of atopic dermatitis, he or she will use the minimum exposure necessary and monitor the skin carefully.
When other treatments are not effective, need systemic corticosteroids, drugs that are taken by mouth or injected into muscle instead of being applied directly to the skin. An example of a commonly prescribed corticosteroid is prednisone. Typically, these medications are used only in resistant cases and are only given for short periods of time.
In adults, immunosuppressive drugs, such as cyclosporine, are also used to treat severe cases of atopic dermatitis that have failed to respond to any other forms of therapy. Immunosuppressive drugs restrain the overactive immune system by blocking the production of some immune cells and curbing the action of others. The side effects of cyclosporine can include high blood pressure, nausea, vomiting, kidney problems, headaches, tingling or numbness, and a possible increased risk of cancer and infections. There is also a risk of relapse after the drug is discontinued. Because of their toxic side effects, systemic corticosteroids and immunosuppressive drugs are used only in severe cases and then for as short a period of time as possible. Patients requiring systemic corticosteroids or immunosuppressive drugs should be referred to a dermatologist or an allergist specializing in the care of atopic dermatitis to help identify trigger factors and alternative therapies.
In extremely rare cases, when no other treatments have been successful, the patient may have to be hospitalized. A five- to seven-day hospital stay allows intensive skin care treatment and reduces the patient’s exposure to irritants, allergens, and the stresses of day-to-day life. Under these conditions, the symptoms usually clear quickly if environmental factors play a role or if the patient is not able to carry out an adequate skin care program at home.
If the disease does not respond to mild treatment then a physician advice is required. With proper treatment, most symptoms can be brought under control within three weeks.
Corticosteroid creams and ointments are the most frequently used for treatment. Since many of these are quite potent it will be necessary to have frequent physician visits to assure that the treatment is successful.
Before use antibiotic, patient needs proper analyze and proper antibiotic. So patient needs a doctor’s advice.
- Oxford hand Book of medical Dermatology
- ABC Of Dermatology
- Roxburgh’s common skin diseases
- Andrew’s Diseases of the skin.
Atopic Dermatitis
TUI - Tibot Urgency Index
Atopic dermatitis is a common, often persistent skin disease that affects a large percentage of the world’s population. The condition rarely starts before 4–6 weeks of age and usually begins between the ages of 2 and 3 months. Atopic dermatitis is a special type of allergic hypersensitivity that is associated with asthma, inhalant allergies (hay fever), and a chronic dermatitis. There is a known hereditary component of the disease, and it is more common in affected families. Criteria that enable to analyze it include the typical appearance and distribution of the rash in a patient with a personal or family history of asthma and/or hay fever.
The term atopic is from the Greek meaning strange. The term dermatitis means inflammation of the skin. Many physicians and patients use the term eczema when they are referring to this condition. Sometimes it is called neuro-dermatitis. Atopic dermatitis (eczema) is a condition that makes skin red and itchy. But when it long-lasting, red, itchy rashes, could be atopic dermatitis. Some major and some minor feature are:
Major features
- Itching
- Characteristic rash in locations typical of the disease (arm folds and behind knees)
- Chronic or repeatedly occurring symptoms
- Personal or family history of atopic disorders (eczema, hay fever, asthma)
Some minor features
- Early age of onset
- Dry, rough skin
- High levels of immunoglobulin E (IgE), an antibody, in the blood
- Ichthyosis
- Hyper linear palms
- Keratosis pilaris
- Hand or foot dermatitis
- Cheilitis (dry or irritated lips)
- Nipple eczema
- Susceptibility to Skin infection
- Positive allergy skin tests
Although atopic dermatitis can occur in any age, most often it affects infants and young children. Occasionally, it may persist into adulthood or may rarely appear at that time. Some patients tend to have a protracted course with ups and downs. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, which are followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis enter into a permanent remission of the disease when they get older, although their skin may remain somewhat dry and easily irritated.
Although symptoms and signs may vary from person to person, the most common symptoms are dry, itchy, red skin. Itch is the hallmark of the disease. Typically, affected skin areas include the folds of the arms, the back of the knees, wrists, face, and neck.
The itchiness is an important factor in atopic dermatitis, because scratching and rubbing can worsen the skin inflammation that is characteristic of this disease. People with atopic dermatitis seem to be more sensitive to itching and feel the need to scratch longer in response. They develop what is referred to as the itch-scratch cycle. The extreme itchiness of the skin causes the person to scratch, which in turn worsens the itch, and so on. Itching is particularly a problem during sleep, when conscious control of scratching decreases and the absence of other outside stimuli makes the itchiness more noticeable.
The cause of atopic dermatitis is not known, but the disease seems to result from a combination of genetic (hereditary) and environmental factors. There seems to be a basic cutaneous hypersensitivity and an increased tendency toward itching. Evidence suggests that the disease is associated with other so-called atopic disorders such as hay fever and asthma, which many people with atopic dermatitis also have. Many children, who outgrow the symptoms of atopic dermatitis, develop hay fever or asthma. Although one disorder does not necessarily cause another, they may be related, thereby giving researchers clues to understanding atopic dermatitis. Many of those affected seem to have either a decreased quantity of or a defective form of a protein in their skin. This protein seems to be important in maintaining normal cutaneous hydration. It is important to understand that food sensitivities do not seem to be a major inciting factor for most cases of atopic dermatitis.
Patients with atopic dermatitis seem to have mild immune system weakness. They are predisposed to develop fungal foot disease and cutaneous staphylococcal infections. They can disseminate herpes simplex lip infections (eczema herpeticum) and smallpox vaccination (eczema vaccinatum) to large areas of skin.
While emotional factors and stress may sometimes exacerbate the condition, they do not seem to be a primary or underlying cause for the disorder.
Trigger factors:
Some things that trigger atopic dermatitis or make it worse include:
- Strong soaps and detergents
- Some fabrics, like wool or scratchy materials
- Perfumes, skin care products, and makeup
- Pollen and mold
- Animal dander
- Tobacco smoke
- Stress and anger
- Dry winter air/low humidity
- Long or hot showers/baths
- Dry skin
- Sweating
- Dust or sand
- Certain foods (usually eggs, dairy products, wheat, soy, and nuts)
If the disease does not respond to mild treatment then a physician advice is required. With proper treatment, most symptoms can be brought under control within three weeks.
Corticosteroid creams and ointments are the most frequently used for treatment. Since many of these are quite potent it will be necessary to have frequent physician visits to assure that the treatment is successful.
Tacrolimus and pimecrolimus are non-steroid topical ointments that contain molecules that inhibit a substance called calcineurin which is important in inflammation. They are used for the treatment of atopic dermatitis. They are particularly effective in when used on the faces of children since they seem less likely to produce atrophy. It is used as a immune modulators.
Crisaborole is a topical treatment for children and adults. Mild to moderate atopic dermatitis is seems to work by inhibiting a different portion of the inflammatory cascade in skin.
Dupilumab is a treatment of moderate to severe atopic dermatitis in adults. It is an anti-IL-4 antibody that is given by injection twice a month and shows great promise in the control of severe atopic dermatitis.
Atopiclair, MimyX, and CeraVe is repair and improve the skin’s barrier function in both children and adults. These creams may be used in combination with topical steroids and other emollients to help repair the overall dryness and broken skin function.
Additional available treatments may help to reduce specific symptoms of the disease. Oral antibiotics to treat staphylococcal skin infections can be helpful in the face of pyoderma. Certain antihistamines that cause drowsiness can reduce night time scratching and allow more restful sleep when taken at bedtime. This effect can be particularly helpful for patients whose night time scratching aggravates the disease. If viral or fungal infections are present, need medications to treat those infections.
Phototherapy is treatment with light that uses ultraviolet A or B light waves or a combination of both. This treatment can be an effective treatment for mild to moderate dermatitis in older children (over 12 years old) and adults. Photochemotherapy, a combination of ultraviolet light therapy and a drug called psoralen, can also be used in cases that are resistant to phototherapy alone. Possible long-term side effects of this treatment include premature skin aging and skin cancer. Phototherapy may be useful in treating the symptoms of atopic dermatitis, he or she will use the minimum exposure necessary and monitor the skin carefully.
When other treatments are not effective, need systemic corticosteroids, drugs that are taken by mouth or injected into muscle instead of being applied directly to the skin. An example of a commonly prescribed corticosteroid is prednisone. Typically, these medications are used only in resistant cases and are only given for short periods of time.
In adults, immunosuppressive drugs, such as cyclosporine, are also used to treat severe cases of atopic dermatitis that have failed to respond to any other forms of therapy. Immunosuppressive drugs restrain the overactive immune system by blocking the production of some immune cells and curbing the action of others. The side effects of cyclosporine can include high blood pressure, nausea, vomiting, kidney problems, headaches, tingling or numbness, and a possible increased risk of cancer and infections. There is also a risk of relapse after the drug is discontinued. Because of their toxic side effects, systemic corticosteroids and immunosuppressive drugs are used only in severe cases and then for as short a period of time as possible. Patients requiring systemic corticosteroids or immunosuppressive drugs should be referred to a dermatologist or an allergist specializing in the care of atopic dermatitis to help identify trigger factors and alternative therapies.
In extremely rare cases, when no other treatments have been successful, the patient may have to be hospitalized. A five- to seven-day hospital stay allows intensive skin care treatment and reduces the patient’s exposure to irritants, allergens, and the stresses of day-to-day life. Under these conditions, the symptoms usually clear quickly if environmental factors play a role or if the patient is not able to carry out an adequate skin care program at home.
If the disease does not respond to mild treatment then a physician advice is required. With proper treatment, most symptoms can be brought under control within three weeks.
Corticosteroid creams and ointments are the most frequently used for treatment. Since many of these are quite potent it will be necessary to have frequent physician visits to assure that the treatment is successful.
Before use antibiotic, patient needs proper analyze and proper antibiotic. So patient needs a doctor’s advice.
- Oxford hand Book of medical Dermatology
- ABC Of Dermatology
- Roxburgh’s common skin diseases
- Andrew’s Diseases of the skin.
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