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Atopic Dermatitis

Atopic dermatitis (atopic eczema) is a relapsing, inflammatory, pruritic and eczematous skin disorder.


Presentation

The areas of skin most commonly affected are the skin folds like folds of arms, behind of knees, wrists, face and hands. In children, the extensor surfaces of limbs are commonly involved whereas in adults, usually the flexor surfaces get affected. The patients of atopic dermatitis present with the following clinical features [4] [5]:

Of the patients who develop atopic dermatitis before the age of 2 years, 50% are likely to develop other forms of allergic reactions later in life.

Sleep Apnea
  • BACKGROUND: Atopic dermatitis (AD) is associated with systemic inflammation and may have a similar pathogenesis as obstructive sleep apnea (OSA). However, to date, studies on the association between AD and OSA are limited.[ncbi.nlm.nih.gov]
Thrombosis
  • Left ventricular (LV) asynergy and thrombus was detected on echocardiography, and superior mesenteric vein thrombosis was detected by computed tomography. There are no reported cases of this combination of thrombi.[ncbi.nlm.nih.gov]
Eczema
  • […] of face Eczema of leg Eczema of wrist Eczema, atopic Erythrodermic atopic dermatitis Flexural atopic dermatitis Flexural eczema Follicular atopic dermatitis Generalized atopic dermatitis Intrinsic eczema Inverse pattern atopic dermatitis K bner phenomenon[icd9data.com]
  • Eczema Patients (14124435164).jpg 607 414; 267 KB Daumen infektion.jpg 2 240 3 343; 2,22 MB Delineations of Cutaneous Diseases Exhib.pdf 1 275 1 650, 360 pagine; 33,11 MB Dermatite o eczema atopico avambraccio 2015.jpg 3 264 2 448; 1,15 MB Dermatitis[commons.wikimedia.org]
  • Eczema Patients (14124435164).jpg 607 414; 267 KB Daumen infektion.jpg 2.240 3.343; 2,22 MB Delineations of Cutaneous Diseases Exhib.pdf 1.275 1.650, 360 Seiten; 33,11 MB Dermatite o eczema atopico avambraccio 2015.jpg 3.264 2.448; 1,15 MB Dermatitis[commons.wikimedia.org]
  • - common allergens.jpg 468 468;24キロバイト Atopic eczema - common irritants.jpg 468 468;29キロバイト Atopy2010.JPG 3,110 2,660;1.2メガバイト Bateman porrigo larvalis.jpg 670 898;52キロバイト Better Sleep for Eczema Patients (13937464919).jpg 607 414;220キロバイト Changing Diet[commons.wikimedia.org]
  • There was no significant difference in Eczema Area Severity Index score between the standard care and text message groups at follow-up, with mean decreases in Eczema Area Severity Index score of 53% and 58%, respectively.[ncbi.nlm.nih.gov]
Dry Skin
  • In contrast to pathomechanisms of dry skin observed in SS, we recently reported that reduced sweating function and dry skin seen in atopic dermatitis (AD) are mediated by histamine or substance P, those are usually restored to normal levels after improvement[ncbi.nlm.nih.gov]
  • Atopic dermatitis (AD) is a common chronic inflammatory skin disease with epidermal barrier defects which leads to dry skin that is easily disturbed by external exacerbating factors.[ncbi.nlm.nih.gov]
  • In addition to reducing identifiable triggers, treatment should focus on the four clinical characteristics of eczema: emollients for dry skin, topical anti-inflammatory agents to reduce inflammation and itch, and strategies to reduce infection/colonization[ncbi.nlm.nih.gov]
  • In order to qualify as a case of atopic dermatitis, we propose that an individual must have an itchy skin condition plus three or more of the following: history of flexural involvement, a history of asthma/hay fever, a history of a generalized dry skin[ncbi.nlm.nih.gov]
  • BACKGROUND: Atopic dermatitis (AD) is a chronic relapsing, noncontagious skin inflammation characterized by dry skin and itch.[ncbi.nlm.nih.gov]
Pruritus
  • Pruritus was graded on a 4-point scale of none (0) to severe (3). Early improvement in pruritus required a score of none (0) or mild (1), with a  1-grade improvement from baseline on day 6.[ncbi.nlm.nih.gov]
  • […] of pruritus in atopic dermatitis.[doi.org]
  • Pruritus causes significant impairment in the quality of life of patients suffering from atopic dermatitis. Treatments for itch in atopic dermatitis range from simple avoidance of pruritus triggers to more complicated systemic therapy.[ncbi.nlm.nih.gov]
  • Although pruritus is the critical symptom of atopic dermatitis that profoundly affect the patients' quality of life, controlling and management of prurirtus still remains as unmet needs mainly due to the distinctive multifactorial pathogenesis of pruritus[ncbi.nlm.nih.gov]
  • Atopic dermatitis (AD) is a common inflammatory dermatosis characterized by pruritus, erythema, induration, and lichenification.[ncbi.nlm.nih.gov]
Lichenification
  • Atopic dermatitis (AD) is a common inflammatory dermatosis characterized by pruritus, erythema, induration, and lichenification.[ncbi.nlm.nih.gov]
  • 3 phases of atopic dermatitis: - infantile (2 months to 2 years): - facial and extensor distribution - childhood - greater tendency to xerosis - flexural distribution - more lichenification and excoriations - adult - atopic dermatitis generally improves[dermweb.com]
  • Childhood atopic dermatitis with xerosis, superficial crusts, lichenification and excoriations. Figure 5. Lichenification of the hands seen in a patient with severe and chronic atopic dermatitis.[clinicaladvisor.com]
  • Your child’s skin may also become thicker, called lichenification, from too much scratching and rubbing. The appearance of atopic dermatitis may differ from one child to another.[nationaleczema.org]
Papule
  • A 14-year-old patient with severe widespread atopic dermatitis (AD) and concurrent molluscum contagiosum virus (MCV) presented with MCV papules that were surrounded by dermatitis-free zones.[ncbi.nlm.nih.gov]
  • Lichen simplex chronicus (LSC) is a skin disorder characterized by chronic itching and scratching, which can lead to thick, leathery, brownish skin, sometimes with papules and can be associated with atopic eczema.[ncbi.nlm.nih.gov]
  • Atopic dermatitis is a chronic disabling inflammatory skin disorder, typically characterized by intensely itching, oozing, crusted, eroded vesicles or papules developing on erythematous plaques.[ncbi.nlm.nih.gov]
  • Lichen amyloidosis (LA) is a subtype of primary cutaneous amyloidosis that is presented as persistent, multiple-grouped hyperkeratotic papules usually located on the shins, back, forearms or thighs.[ncbi.nlm.nih.gov]
  • […] appearance or basic morphology of atopic dermatitis is more difficult to describe • pruritus is usually the most outstanding clinical feature • depending on the acuity of the skin disease there can be: - ill-defined erythema - tiny coalescing edematous papules[dermweb.com]
Neglect
  • At the extreme end, such beliefs may result in neglect constituting reportable child maltreatment. We examine the legal repercussions of such abuse in the criminal case resulting from the death of Gloria Sam.[ncbi.nlm.nih.gov]

Workup

No specific diagnostic tests are available for atopic dermatitis. Patient’s history and examination are helpful in reaching a diagnosis. Serum testing for IgE antibodies can be used to detect ongoing allergic reactions in the body.

It is essential to differentiate atopic dermatitis from other closely related diseases like seborrhic dermatitis on the basis of signs and symptoms and close examination of the manifestations.

Eosinophils Increased
  • Eosinophils increase neuron branching in human and murine skin and in vitro. Plos One. 2011; 6 ((7)):e22029. [ PMC free article : PMC3140999 ] [ PubMed : 21811556 ] Grimstad O, Sawanobori Y, Vestergaard C, Bilsborough J, Olsen U.[ncbi.nlm.nih.gov]

Treatment

Conservative treatment of atopic dermatitis includes the following [6]:

  • Anti-inflammatory agents such as topical and systemic corticosteroids are administered. Topical steroids are preferred because they have less systemic side effects. Systemic corticodteroids are used in severe disease.
  • Immunosuppressant drugs may also be given to the patients suffering from atopic dermatitis [7].
  • Topical emollients can also be used and usually have a good outcome [8] [9].
  • Antibiotics are given to prevent secondary bacterial infections in these patients (particularly when immunosuppressive drugs are used).
  • Antihistamines can be used to prevent the allergic mediators from exaggerating this disease.

Surgical measures for atopic dermatitis include the following:

  • Phototherapy with UVA (ultraviolet light with a frequency of 320 to 400 nanometers) or UVB (ultraviolet light with a frequency of 290 to 300 nanometers) is an effective mode of treatment in children as well as in adults [10]. Sometimes both types of ultraviolet light are used.
  • Photochemotherapy consists of phototherapy combined with chemotherapy and is given in patients with more severe disease.

Prognosis

  • Our clinicopathological review revealed that the prognosis of C-ALCL occurring in patients with AD is poor because two of 5 patients died of disease.[ncbi.nlm.nih.gov]
  • Only an estimated 10% of patients older than 20 years continue to be symptomatic. [5] Prognosis The prognosis is good if the inflammation can be kept under control with therapy.[emedicine.medscape.com]
  • Prognosis Mortality is not associated with atopic dermatitis. The impact of eczema is hard to measure but has real personal, social, and financial consequences.[emedicine.com]

Etiology

Various genetic and environmental factors are thought to give rise to atopic dermatitis like the following:

Factors like pets, woolen clothing or exposure to pollens are the predisposing factors for the development of this disease.

Epidemiology

In developed countries, the disease is found in 15-30% children and in 2-10% of the adult population. Atopic dermatitis has been linked to living in ‘excessively sanitary’ conditions.

A slight prevalence of disease in females as compared to the males has been reported. All races are equally affected. No specific geographic distribution, other than in pollen dense areas, has been found.

Sex distribution
Age distribution

Pathophysiology

Two different theories have been proposed regarding the pathogenesis of atopic dermatitis [2] [3].

  • The structural and functional abilities of the epidermis are lost as a result of mutations in the filaggrin gene. The barrier function of epidermis is, thereby, impaired and the first line of defense against external agents is lost. Water is lost from the skin, making it dry and itchy.
  • The second theory is centered on the concept of autoimmune reaction occurring in the body. The immune cells like macrophages, Langerhans cells, helper T cells (in the initial stages, Th2 and later, Th1 is involved) inflammatory cytokines, interleukins (IL4, IL5 and tumor necrosis factor) and several other immune mediators are activated as a result of exposure to environmental allergens and give rise to signs and symptoms of inflammation; flare, redness and erythema. All these immune mediators give rise to pruritus. This theory is more widely accepted as compared to the first one.

Prevention

The preventive measures against atopic dermatitis include:

  • Observing skin hygiene.
  • Paying special attention to hygiene and sanitary measures in infants and children as they are more likely to acquire to the disease.
  • Avoiding excessive use of skin care products right after taking showers or baths.
  • Avoiding harsh soaps and skin wash products.
  • Frequently washing the bed linens, towels, clothing, utensils etc. to prevent the exposure to dust particles that are commonly found on these items.
  • Keeping the skin adequately hydrated, yet avoiding excessive exposure to moisture.
  • Avoiding scratching the vesicles. The doctor should properly advise the patients in this regard.
  • Avoiding environmental, industrial and occupational allergies.
  • Stress and anxiety have proved to be predisposing factors for atopic dermatitis. Therefore, stress should be avoided.

Summary

A commonly occurring inflammatory skin disorder, atopic dermatitis, also known commonly as eczema, is a form of allergic reaction to allergens found in the environment. It is frequently described as a cutaneous manifestation of systemic allergic reactions (atopy) [1].

Atopic dermatitis is more common in children and is characterized by excessively dry, red and itchy skin. Various environmental and genetic factors have been implicated in the development of this disease. Although the condition persists over the years, it is not contagious and can be cured with medication.

Patient Information

Atopic dermatitis is a skin disease that affects children the most. Factors causing this disease mainly involve dust particles and other allergic substances present in the environment. It involves excessive dryness, redness and itching over the skin. Atopic dermatitis gives rise to an urge to scratch which should be avoided as much as possible because the eruptions can peel off, exposing the vulnerable ski underneath. This might become a cause of acquiring infections.

The condition is not contagious and is not transmitted from one person to another. These eruptions can be cured with proper care and treatment.

References

Article

  1. Conde-Taboada A, Gonzalez-Barcala FJ, Toribio J. [Review and update of current understanding of childhood atopic dermatitis]. Actas dermo-sifiliograficas. Nov 2008;99(9):690-700.
  2. Takigawa M, Sakamoto T, Nakayama F, Tamamori T. The pathophysiology of atopic dermatitis. Acta dermato-venereologica. Supplementum. 1992;176:58-61.
  3. Kang K, Stevens SR. Pathophysiology of atopic dermatitis. Clinics in dermatology. Mar-Apr 2003;21(2):116-121.
  4. Guillet G. [Atopic dermatitis:epidemiologic, clinical features, the role of allergy (review)]. Allergie et immunologie. Dec 2000;32(10):393-396.
  5. Oakes RC, Cox AD, Burgdorf WH. Atopic dermatitis. A review of diagnosis, pathogenesis, and management. Clinical pediatrics. Jul 1983;22(7):467-475.
  6. Correale CE, Walker C, Murphy L, Craig TJ. Atopic dermatitis: a review of diagnosis and treatment. American family physician. Sep 15 1999;60(4):1191-1198, 1209-1110.
  7. Naeyaert JM, Lachapelle JM, Degreef H, de la Brassinne M, Heenen M, Lambert J. Cyclosporin in atopic dermatitis: review of the literature and outline of a Belgian consensus. Dermatology. 1999;198(2):145-152.
  8. Yun Y, Kim K, Choi I, Ko SG. Topical herbal application in the management of atopic dermatitis: a review of animal studies. Mediators of inflammation. 2014;2014:752103.
  9. Simpson EL. Atopic dermatitis: a review of topical treatment options. Current medical research and opinion. Mar 2010;26(3):633-640.
  10. Meduri NB, Vandergriff T, Rasmussen H, Jacobe H. Phototherapy in the management of atopic dermatitis: a systematic review. Photodermatology, photoimmunology & photomedicine. Aug 2007;23(4):106-112.

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Last updated: 2019-07-11 21:30