About Atopic Dermatitis (Eczema)

Overview

Atopic dermatitis, also known as atopic eczema, is a chronic inflammatory skin condition characterized by dry, itchy skin and red rashes that come and go. It typically begins in early infancy but can persist into adulthood or even start in adulthood. The rashes can appear on any part of the body, with different patterns depending on age.

In infants, affected areas commonly occur on the face, scalp, hands, and feet. In children, the rashes are often found in the bend of the elbows and knees and on the front of the neck. In adolescents and adults, they typically occur on the wrists, ankles, eyelids, as well as the bend of the elbows and knees. Scratching the itchy skin can lead to oozing, crusting, and thickening of the skin. Atopic dermatitis is usually associated with allergies.

Causes and Risk Factors

The pathophysiologic causes of atopic dermatitis are complex and involve multiple factors, including:

• Genetic predisposition: Atopic dermatitis is strongly influenced by genetic factors. Patients with a personal or familial history of other allergic diseases, such as asthma and allergic rhinitis, are at increased risk due to genetic mutations associated with defective skin barrier formation.
• Immune dysregulation: Activation of the T helper 2 (Th2) cell-mediated pathway and neuroimmune interactions contribute to the development of atopic dermatitis.
• Skin barrier impairment: Defects in the barrier function of keratinocytes lead to dry, itchy, and cracked skin, which is a hallmark of atopic dermatitis.

Non-modifiable risk factors for atopic dermatitis cannot be controlled or changed. Family history is a non-modifiable risk factor. Having a family history of atopic diseases, particularly if one or both parents have atopic dermatitis, increases the risk.

Modifiable risk factors for atopic dermatitis can be influenced by individual habits and lifestyle. They include several environmental factors, including:

• Living in an urban setting
• Low UV light exposure
• Living in a dry climate
• Western diet
• Repeated exposure to antibiotics in early childhood

It's important to note that while these risk factors may increase the likelihood of developing atopic dermatitis, they do not guarantee its occurrence. It is a complex condition influenced by a combination of genetic and environmental factors. Consult with your healthcare professional for personalized advice.

Symptoms

Common symptoms of atopic dermatitis include:

• Itching, which can be severe.
• Red to dark brown, dry patches of skin.
• Rashes that may ooze, weep clear fluid, or bleed when scratched.

As atopic dermatitis progresses or reaches higher severity, the following symptoms may occur:

• Thickening and hardening of the skin.
• Appearance of the rash in multiple spots at the same time.
• Other conditions such as asthma and allergies, including food allergies.
• Other skin diseases like ichthyosis, which causes dry, thickened skin.
• Depression or anxiety.
• Sleep loss.

It's important to note that symptoms can vary from person to person and may differ depending on age. For infants, a red rash may appear on the face, scalp, and areas of skin around joints that touch when bending. Darker skin tones may experience darkening or lightening of the affected areas.

If you experience any of these symptoms, it's best to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

Diagnosis

To diagnose atopic dermatitis, healthcare providers often perform the following examinations, tests, and procedures:

• Medical history review: Doctors will ask about your medical history, including any previous skin conditions or allergies.
• Visual examination: Doctors will examine the location and appearance of the rash on your skin.

Additional examinations, tests, and procedures may include:

• Biopsy: In some cases, doctors may perform a biopsy during the acute stage of eczema to differentiate between atopic dermatitis and other conditions.
• Skin prick testing: This test can help identify specific allergens that may trigger your atopic dermatitis symptoms.
• Allergen-specific IgE blood test: This blood test measures the level of specific antibodies (IgE) in response to potential allergens.
• SCORAD questionnaire: Doctors may use this questionnaire to assess the severity of atopic dermatitis based on factors such as itching, redness, and extent of skin involvement.
• Eczema Area and Severity Index (EASI): This standardized tool helps doctors determine the severity of atopic dermatitis by assessing the area and signs of involvement on different body regions.

It's important to note that these examinations, tests, and procedures should be performed by healthcare professionals.

Treatment Options

The goals of treatment for atopic dermatitis are to manage and control dry skin, reduce skin inflammation, control itching, promote healing, prevent infections, and prevent flares. Treatment options may vary based upon a person’s age and severity of atopic dermatitis. Treatments may include:

Medications:

• Moisturizing creams: Help restore the skin barrier and manage dryness.
• Corticosteroid creams and ointments.
• Calcineurin inhibitor creams and ointments.
• Phosphodiesterase inhibitor creams and ointments.
• Janus kinase (JAK) inhibitor creams or pills.
• Monoclonal antibody injectable medications.
• For short-term use for specific symptoms:
  • Oral steroids: These may be prescribed for short-term use to help control inflammation flares.
  • Antihistamines: These oral medications may be used to help relieve itching.
  • Antibiotic creams or oral pills: These may be recommended or prescribed for skin infections.

Therapies:

• Phototherapy: Uses ultraviolet A or B light waves to treat symptoms of atopic dermatitis.

Self-care and health behavior changes:

• Skin care: Soaking in a bath with colloidal oatmeal and applying moisturizers right after bathing helps keep the skin hydrated.
• Avoiding triggers: Identifying and avoiding triggers unique to you or your child can help prevent flares. Common triggers include stress, laundry detergents or skin care products that contain fragrance, cold weather, hot weather, and wool clothing. Different people may have different triggers.

It's important to note that specific medications and therapies should be prescribed by a doctor based on the severity of the disease and individual factors. Always consult with your healthcare professional for personalized advice.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.