Atopic Dermatitis (Eczema)

Atopic dermatitis is a chronic (long-lasting) disease that causes inflammation, redness, and irritation of the skin. People with atopic dermatitis often have other conditions such as allergies, including food allergies and often atopic dermatitis is hereditary. The disease is very common: up to 20% of children suffer from atopic dermatitis, up to 85% of all episodes of skin inflammation in infants. Adults are less affected: 1 to 3% of people have the disease. Synonyms of the disease are: atopic eczema, neurodermatitis, endogenous eczema.

There is a difference between the atopic dermatitis and allergic dermatitis. People who suffer from allergic dermatitis have the process developed after direct contact of the dermis with any specific allergen, while those who have atopic dermatitis have predisposition to inflammation in response to certain allergenic factors. Hence there are frequent combination of atopic dermatitis with other systemic allergic diseases: bronchial asthma, food intolerance, rhinitis, rhinoconjunctivitis, etc.

Classification of dermatitis

A generally accepted clinical classification of atopic dermatitis is still being developed. Currently, dermatologists rely on the age of the patient (phases of neurodermatitis) and the degree of clinical manifestations of the disease.

Phases of atopic eczema:

1. Infant (2-24 months) An early onset is a characteristic feature of the pathology: at this age, up to 80% of children fall ill for the first time, and most of them have a long-term remission after the attack.
2. Childhood phase(2 to 12 years)As a rule, children who did not manage to cope with the disease in infancy pass into it, but at this age, the initial appearance of neurodermatitis is also possible. It is characterized by inflammation of large areas of the skin, severe symptoms.
3. Adolescent and adult phases of neurodermatitis (12 years and older). It has its own characteristics of the course and treatment. Skin lesions are diverse, psychological problems arise, primarily for adolescents.

Endogenous eczema of infancy is considered a benign variant of the disease. With proper treatment majourity of patients have periods of exacerbations reduced, and by the age of 5 they stop. The general principle of the course of the disease is that skin of different age reacts differently to allergization. So, infant’s atopic dermatitis is manifested by general inflammatory reactions: areas of edema, vesicles, crusts.

With age, the variety of symptoms increases: acute inflammation is less common, but other problems come: peeling, pigmentation and other defects.

Causes

The essence of neurodermatitis is that the skin is oversaturated with nonspecific IgE immunoglobulins. These molecules that are responsible for the development of allergies. As a result, any effect on the dermis leads to the release of IgE and triggers a cascade of reactions characteristic of the immune response: aseptic inflammation, increased vascular permeability, etc.

Specific reasons for the development of atopic dermatitis cannot be identified, so the disease is considered polyetiological. However, studies have shown that there are a number of factors that increase the risk of the disease:

1. Genetic predisposition (familial atopy). The risk of getting sick is higher for those who have relatives suffering from asthma and atopic dermatitis. In more detail: the risk is higher with mutations in the FLG gene. It is responsible for the synthesis of proteins that regulate the maturation of the skin.
2. Bacterial or viral infection. Staphylococcus aureus, which lives on the body of all people, is considered an irritant for the immune system of the skin. Also, a herpetic attack can give a start to neurodermatitis.
3. Excessive hygiene. The child's skin does not have time to "get acquainted" with antigens. This reduces the risk of infections, but increases the likelihood of neurodermatitis in the childhood or adolescent phase.
4. Climate change. Faced for the first time with new physical factors (cold or heat), the body perceives them as an allergen and reacts in the usual way: it releases immunoglobulins in the dermis.
5. Food allergens: Their association with atopic dermatitis has not been conclusively proven. But, of course, you need to refuse products that cause food allergies.
6. Smoking in the family may increase the risk of endogenous eczema in children. Here, the sensitizing factor is the particles of tobacco smoke.

It is questionable whether gender of patient has impact on the development of the disease: for every 10 ill men, there are, on average, 14 women with endogenous eczema.

Also, studies do not confirm that the development of atopic dermatitis is affected by cesarean delivery or vaginal delivery: this is a myth.

Symptoms 

Symptoms depend on the severity and prescription of the process, the age of the patient, and are often disguised as other diseases.

Sometimes, atopic dermatitis on the face is similar to the manifestations of systemic lupus erythematosus, so we recommend that you consult a Universum clinic dermatologist if a child or an adult develops one of the following symptoms:

• skin itching;
• inflammation and redness of the skin on the cheeks and neck, in the armpits and in the groin;
• in some places increased dryness of the skin (focal xerosis);
• thickening of areas of the epidermis and strengthening of its pattern (lichenification);
• episodes of purulent lesions of the dermis (superinfection with Staphylococcus aureus).

A characteristic feature is the onset of symptoms at an early age (infant phase).

Symptoms of atopic dermatitis are expressed in varying degrees. According to this criterion, 4 degrees of severity of the process are distinguished:

1. The relative norm is the skin without signs of inflammation. It happens in periods of remission, this is the goal of treatment.
2. Mild severity - areas of xerosis, moderate itching.
3. Medium - areas of dry skin are larger, itching is stronger, scratching (excoriation), redness are noted;
4. A severe degree of atopic dermatitis is a gross deterioration in the quality of life, extensive areas of xerosis and lichenification, intolerable itching, scratching, cracks and weeping, pigmentation.

Due to the fact that neurodermatitis often occurs in childhood, infants cannot  tell about their problem. We recommend  parents to pay attention to signs of the disease in order to show the child to a pediatric dermatologist in time.

Children’s signs of atopic dermatitis

If the disease proceeds typically, then rashes, crusts, peeling appear on the cheeks and face of the baby. Attempts to change the diet do not always lead to recovery. Children do not sleep well due to itching, act up, lose their appetite and gain weight poorly. Mother if the  child tries to carefully take care of the baby's skin, and often this only worsens the baby's condition.

The disease is prone to an undulating course, when the symptoms subside and the skin clears up. This is a period of spontaneous remission. after it, an exacerbation often occurs with damage to a larger area of the skin.

We recommend parents of children with similar symptoms to contact the Universum clinic: our experts will help you figure out what caused the child's condition and how to help the little patient. At the same time - to restore peace to mom and dad. 

Atopic dermatitis: consequences

There is no evidence that the disease increases the risk of developing life-threatening diseases (in particular, cancer). The main consequences are associated with symptoms of pathology and skin lesions:

• persistent foci of dryness and lichenification of the dermis on the face, in the folds of the skin;
• eczematous peeling;
• post-infectious lesions - scars, ulcers;
• cracks that do not heal for a long time, bleeding areas;
• psychological disorders due to defects in appearance (typical for adolescents);
• depressive states due to debilitating itching, sleep disturbances and persistent flow, progression of neurodermatitis.

To conclude allabove mentiioned, with a diagnosis of atopic dermatitis, treatment is required, and treatment should be done by a qualified doctor confirmation of the diagnosis.

Diagnostics

An experienced dermatologist can make a diagnosis based on complaints and examination of a patient of any age. Following sympthoms can indicate atopic dermatitis:

• early start;
• itching and dryness;
• eczematous phenomena;
• redness;
• relapsing course;
• family cases of allergic diseases;
• strengthening the relief of the folds on the palms.

To verify the diagnosis, laboratory tests for the level of IgE in the blood and in the skin can be carried out at the Universum Сlinic.

Treatment

As a rule, they are aimed t reduce  the influence of risk factors and improving the quality of life:

• skin hydration;
• pure soap with neutral pH;
• hydrophobic lotions and creams;
• softening components (emollients);
• products with ceramides for skin care;
• topical preparations with corticosteroid hormones;
• immunomodulators;
• ultraviolet irradiation.

In some cases, monoclonal antibodies may be used in treatment. 

Prevention

Unfortunately, there are no measures that would guarantee protection fromthe development of atopic dermatitis.

However, the following steps may work as a preventive measure:

• do not smoke at home;
• cleaning from dust, microscopic mites in bed;
• avoid irritating factors (sudden temperature changes, aggressive detergents);
• use hypoallergenic soap with a neutral pH;
• wear underwear and clothes made of cotton, avoid woolen things.

As for the diet, all foods that can cause diathesis or food allergies should be removed from the menu. First of all - peanuts, eggs, seafood, milk, soy and chocolate.

Literature

1. Eichenfield LF, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb;70(2):338-51. doi: 10.1016/j.jaad.2013.10.010. Epub 2013 Nov 27. PMID: 24290431; PMCID: PMC4410183.
2. Ständer S. Atopic Dermatitis. N Engl J Med. 2021 Mar 25;384(12):1136-1143. doi: 10.1056/NEJMra2023911. PMID: 33761208.
3. Strathie Page S, Weston S, Loh R. Atopic dermatitis in children. Aust Fam Physician. 2016 May;45(5):293-6. PMID: 27166464.
4. Sidbury R, Kodama S. Atopic dermatitis guidelines: Diagnosis, systemic therapy, and adjunctive care. Clin Dermatol. 2018 Sep-Oct;36(5):648-652. doi: 10.1016/j.clindermatol.2018.05.008. Epub 2018 Jun 1. PMID: 30217277.
5. Ramírez-Marín HA, Silverberg JI. Differences between pediatric and adult atopic dermatitis. Pediatr Dermatol. 2022 May;39(3):345-353. doi: 10.1111/pde.14971. Epub 2022 Mar 16. PMID: 35297082.