Atopic dermatitis

Symptoms of Atopic Dermatitis 

Signs and symptoms of atopic dermatitis can vary based on age and racial factors. The most common symptoms include:

• Itching, redness, rashes

• Patchy and dry skin (Xerosis)

• Thickening and hardening of skin

• Blisters that ooze and crust over

• Creases and discolored skin beneath lower eyelids (Dennie-Morgan folds) in children

• Persistent eczema, often on hands, feet, or around the eyes.

• Higher risk of skin infections

Causes Of Atopic Dermatitis

Atopic dermatitis is a complicated condition that comes from several different causes. These include

1. Skin barrier dysfunction

• In atopic dermatitis, the skin's outer layer (stratum corneum) is weakened, causing excess water loss and dryness.

• This damaged barrier lets irritants, allergens, and microbes enter easily, leading to inflammation and worsening the condition.

2. Altered immune response

• The immune system in affected individuals tends to overreact to triggers like allergens, leading to inflammation and itching. 

• T cells and other immune cells release inflammatory mediators, including cytokines, which contribute to persistent skin inflammation.

3. Disruption of the skin's microbial balance

• The skin's microbial composition is important in maintaining a healthy skin barrier and immune function. 

• In atopic dermatitis, the balance of microorganisms on the skin's surface is disrupted, leading to an overgrowth of harmful bacteria and a decrease in beneficial microbes.

• This dysfunction further exacerbates inflammation and contributes to atopic dermatitis.

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Risk Factors For Atopic Dermatitis

Factors that can lead to atopic dermatitis or worsen its symptoms include:

1. Genetics

• Genetics plays a role in atopic dermatitis, as family history and specific gene mutations can increase the likelihood of developing eczema by affecting skin barriers and immune responses.
  
  

2. Environmental factors

• Allergens: Such as pollen, pet dander, smoke from tobacco, and certain foods can trigger or worsen symptoms.

• Irritants: Like harsh soaps, detergents, perfumes, and chemicals can further irritate the skin.

• Temperature and humidity: Extreme temperatures, low humidity, or excessive sweating can provoke symptoms.

• Microbes: Bacterial, viral, or fungal infections can aggravate atopic dermatitis, particularly in cases where the skin is already compromised.

3.. Hormones

• Hormonal changes, such as those occurring during puberty or in women during the menstrual cycle, can influence the severity of atopic dermatitis.

4. Stress and emotional factors

• Stress and emotional states can exacerbate atopic dermatitis symptoms or trigger flare-ups.

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5. Dietary factors

• While rare, certain food allergies, particularly in infants and young children, may trigger or worsen atopic dermatitis. 

• Common culprits include cow's milk, eggs, soy, wheat, peanuts, and fish.

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Diagnosis Of Atopic Dermatitis

To diagnose atopic dermatitis, a thorough examination of the skin and a detailed medical and family history review are crucial. In cases of uncertainty or for confirmation of the diagnosis, the following tests can be conducted:

1. Patch testing

• Patch testing may be conducted to identify specific allergens or irritants that may be triggering or exacerbating the symptoms. 

• It involves applying small amounts of potential allergens to the skin to see if they cause a reaction.

2. Allergy testing

• Allergy testing may be done to identify specific allergens that could be contributing to the atopic dermatitis symptoms. Tests include

  • Skin prick tests 

  •  IgE levels

3. Skin biopsy (Rarely)

• In certain cases where the diagnosis is unclear a skin biopsy may be performed. 

• It involves the extraction of a small piece of skin tissue, which is then analyzed under a microscope to validate the diagnosis.

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Prevention Of Atopic Dermatitis

Atopic dermatitis can't be fully prevented, but steps can be taken to reduce the risk of flare-ups. 

• These include keeping the skin well-moisturized, avoiding known triggers (like harsh soaps, allergens, and stress), and maintaining a consistent skincare routine. 

• Early intervention and proper management can help minimize symptoms and prevent worsening.

• eer clear of triggers like specific foods, environmental allergens, or irritants that worsen your symptoms.

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Preventive tips for children

Atopic dermatitis can't be cured, but it often improves with age. Flare-ups can happen, so to prevent them, ensure your child:

• Avoids triggers like irritants (e.g., wool, harsh soaps), allergens (e.g., eggs, dust mites), and stress.

• Refrains from scratching to prevent worsening symptoms and infection.

• Keeps short fingernails to minimize scratching.

• Take warm, not hot, baths or showers and gently dry the skin.

• Uses moisturizers, applying creams or ointments after bathing.

• Wears soft clothing, avoiding rough fabrics like wool.

• Stays cool to reduce discomfort.

• Avoids the smallpox vaccine, as it's not recommended for people with atopic dermatitis.

Doctor To Visit

The specialists who will help you with your atopic dermatitis  are:

• General physicians
• Dermatologists
• Allergists
• Pediatricians

A general physician can help manage atopic dermatitis by prescribing treatments, offering lifestyle advice, identifying triggers, providing referrals to specialists, and monitoring skin health.

Dermatologists specialize in treating atopic dermatitis by addressing skin barrier issues and prescribing treatments to alleviate symptoms.

Allergists identify triggering allergens and develop personalized management plans to help patients avoid exacerbations of atopic dermatitis.

Pediatricians play a crucial role in early diagnosis, comprehensive care, and guidance for managing atopic dermatitis in children, collaborating with specialists for a holistic approach.

When to see a doctor?

The symptoms of atopic dermatitis are sometimes mild and at other times, severe. So, please contact your doctor when: 

• You experience excessive itching and dryness

• Your symptoms affect your productivity and sleep 

• Over-the-counter medications do not bring any relief and the skin infection worsens

• Fever follows the symptoms

If you are having any such symptoms, immediately consult our skin specialist.
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Treatment Of Atopic Dermatitis

The management of atopic dermatitis focuses on alleviating symptoms, diminishing inflammation, and avoiding flare-ups. It may involve a combination of the following strategies:

1. Emollients (Moisturizers)

Using thick, fragrance-free moisturizers is essential to maintain the skin's natural moisture barrier, thereby reducing dryness and itching.

Soothe the itch with cold moisturizers or gels.
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2. Topical Steroids

The choice of topical corticosteroid for children depends on their age and the area that needs treatment. Commonly used ones are:

• Hydrocortisone 
• Triamcinolone
• Fluocinolone
• Mometasone
  
  

3. Topical calcineurin inhibitors

Calcineurin inhibitors help reduce inflammation and prevent flares. Examples include: 

• Tacrolimus
• Pimecrolimus
  
  

4. Antihistamines

These can help alleviate itching and discomfort associated with atopic dermatitis. Examples include:

• Diphenhydramine 
• Chlorpheniramine
• Cetirizine
• Loratadine
• Fexofenadine
• Doxylamine

5. Antibiotics

These may be prescribed to treat bacterial infections that can develop alongside eczema. It includes: 

• Clindamycin
• Dicloxacillin

6. Immunosuppressants 

In some cases, immunosuppressant drugs may be necessary to manage atopic dermatitis. 

Options include: 

• Azathioprine
• Methotrexate
• Cyclosporine

7. Injectable medication (monoclonal antibodies)

These drugs work by inhibiting immune system proteins, thereby soothing the immune response and leading to reduced inflammation and milder symptoms. Commonly used ones are:

• Tralokinumab
• Dupilumab

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Home care For Atopic Dermatitis

Here are some home remedies that can complement your treatment and help relieve atopic dermatitis symptoms:

1. Oatmeal baths: Soaking in an oatmeal bath can provide relief from itching and inflammation.

How to do it?
Simply finely grind plain, unflavored oats and incorporate them into your bathwater.

2. Coconut oil (Nariyal ka tel): Applying virgin coconut oil to affected areas may help soothe dry and itchy skin due to its moisturizing and anti-inflammatory properties.

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3. Aloe vera: Aloe vera gel, especially when kept in the refrigerator for a cooling effect, can provide relief from itching and help with skin inflammation.

4. Honey (Shahad):  Honey has natural antibacterial properties and can help soothe the skin.

How to use it?
Apply a thin layer of honey to the affected area and cover with a clean cloth or bandage.

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5. Primrose oil: When taken as a supplement, may potentially help alleviate symptoms of atopic dermatitis due to its anti-inflammatory properties.

Note: Always consult with your doctors before starting any supplements.

6. Sunflower seed oil (SSO): It relieves atopic dermatitis by hydrating the skin and reducing inflammation due to its rich emollient and anti-inflammatory properties.

Complications Of Atopic Dermatitis

Atopic dermatitis (AD) is a long-lasting inflammatory skin condition that can cause complications, impacting both the skin and overall well-being, including emotional health. Here are some possible complications of AD:

1. Bacterial infections

a. Skin and soft tissue infections (SSTI): Individuals with AD are more susceptible to skin infections caused by bacteria, particularly Staphylococcus aureus.

b. Bacteremia: In severe cases, bacteria can enter the bloodstream (bacteremia) through the skin lesions, potentially leading to systemic infections. 

c. Osteomyelitis: It is a bone infection that can occur if the infection spreads to the bones. It can cause pain, swelling, and limited mobility in the affected bone.

d. Septic arthritis: It is an infection in a joint that can result from bacteria entering the joint space through the bloodstream. 

2. Viral infections

a. Eczema herpeticum (EH): EH is a severe complication where the herpes simplex virus (HSV) infects the compromised skin in individuals with AD.

Important!

People with atopic dermatitis should avoid the smallpox vaccine, even if their condition seems controlled, due to the risk of a severe infection called eczema vaccinatum. The live vaccinia virus in the vaccine can replicate and spread, posing a significant danger to individuals with this skin condition.

b. Viral warts: AD patients are prone to viral warts, especially those caused by human papillomavirus (HPV). 

3. Endocarditis

Endocarditis is a rare but serious infection of the heart’s inner lining, often caused by bacteria from a skin infection entering the bloodstream.

4. Hyperpigmentation and Scarring

Chronic inflammation and recurrent flares of atopic dermatitis can lead to changes in skin color (hyperpigmentation) and scarring in the affected areas.

5. Psychological and emotional Impact

Living with a chronic skin condition like atopic dermatitis can have a significant emotional toll. It may lead to stress, anxiety, depression, low self-esteem, and difficulties in social interactions due to the visible and often uncomfortable symptoms.

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Alternative Therapies For Atopic Dermatitis

Complementary and alternative therapies can be considered as adjuncts to conventional treatments for atopic dermatitis (AD) in both adults and children, promoting symptom relief and overall well-being. Consult your doctor before trying any alternative remedies for AD.

Some of them include:

1.  Phytotherapy

• Phytotherapy, or herbal medicine, involves using plant extracts for medicinal purposes. 

• Certain herbs may have anti-inflammatory properties and could be used topically or internally to complement conventional treatments for AD.

2. Bath Therapy

• Bath therapy, often using additives like colloidal oatmeal, baking soda, or apple cider vinegar, can be soothing for AD patients. 

• Baths can help hydrate the skin, reduce itching, and provide relaxation, contributing to overall skin comfort and relief.

3. Probiotics

Probiotic supplements or foods rich in probiotics may support gut health and potentially help in managing AD symptoms by modulating the immune system.

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4. Dietary supplements

• Gamma-linoleic acid: This compound is used to treat AD symptoms and is found in various plant oils, such as borage oil and evening primrose oil.

• Omega-3 fatty acids: These fatty acids possess therapeutic properties for alleviating AD symptoms by mitigating the inflammation associated with the condition.

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5. Homeopathy

Homeopathy for atopic dermatitis uses highly diluted natural substances to stimulate the body’s healing response and reduce symptoms. While some people find it helpful, it's best used alongside conventional treatments due to limited scientific evidence.

Note: Always consult a doctor before using complementary or alternative therapies to ensure they are safe and appropriate for the individual's condition and to avoid any potential interactions with existing treatments.

Living With Atopic Dermatitis

Atopic dermatitis can severely impact quality of life, affecting relationships, work, and overall happiness due to its chronic itching, pain, and skin issues. This can limit daily activities, clothing choices, and social engagements.

Atopic dermatitis, or eczema, can cause itching, irritation, and sensitivity in your skin. Follow these dermatologist-approved tips to ease discomfort and minimize flare-ups.

1. Hydrate and Moisturize: Apply fragrance-free cream or ointment after bathing or whenever your skin feels dry to create a protective barrier.

Quick tip: Seal in moisture after a bath or shower by immediately applying moisturizer to your skin.

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2. Avoid fragrances: Choose skincare products labeled "fragrance-free" to prevent triggering eczema flares. Avoid products labeled "unscented" as they can still contain hidden fragrances.

3. Patch test new products: Test a small amount of a new skincare product on your inner arm for 7-10 days to ensure it doesn't cause a reaction before using it on your skin.

4. Quick, moisturizing baths: Enjoy brief 5-10 minute baths or showers with warm water to keep your skin hydrated. Afterward, apply moisturizer right away to seal in the moisture.

5. Identify triggers: Determine what triggers your eczema and avoid these substances to reduce flare-ups. Eczema-prone skin is sensitive and can react to various everyday factors.

6. Skin-friendly clothing and detergent: Opt for loose-fitting 100% cotton clothing, avoid wool against the skin, and use fragrance-free, dye-free laundry detergent. Wash new clothes before wearing them. Use 100% cotton towels and sheets for additional relief.

7. Manage temperature exposure: Protect your skin from extreme temperatures like cold weather can dry the skin, while overheating and sweating can trigger eczema flare-ups. You can also use a humidifier if dry air makes your skin dry.

To prevent Staphylococcus aureus skin infections, consider these options for controlling colonization in severe or stubborn cases:

• Use a sodium hypochlorite body wash during bath or shower.

• Apply intranasal mupirocin twice a day for 5 days.

• Try bleach-bath therapy by adding a small amount of bleach (one teaspoon per gallon of water in a toddler tub) to reduce bacteria and skin inflammation, thereby alleviating symptoms.

Remember:

Regular follow-ups with doctors and adherence to treatment plans are crucial in managing the condition effectively.