Definition

Atopic dermatitis is a type of skin inflammation triggered by allergenic substances. It is a condition characterized by inflammation of the skin. The term "derm" refers to the skin, while "itis" indicates inflammation. The term "atopy" originates from Greek and refers to an abnormal immune response to allergens.

Atopic dermatitis is a prevalent kind of skin inflammation distinguished by itchy red patches. Typically, these lesions manifest on the face region and the arms and legs. This condition can potentially impair the skin's role as a safeguard or protective barrier (the body's outermost line of defense). Impairment of this function will heighten the skin's sensitivity and increase its vulnerability to infection and dryness.

Atopic dermatitis is a non-communicable skin condition. Its symptoms tend to recur intermittently and persist over an extended duration. Although it primarily affects children, it can also impact adults and approximately 18 million adults worldwide are thought to be afflicted by it.

Causes

The precise etiology of atopic dermatitis remains unknown. Atopic dermatitis can arise from a combination of multiple factors. Atopic dermatitis is an inflammatory condition caused by an exaggerated allergic response. This reaction results in an excessive accumulation of inflammatory cells in the skin, leading to the manifestation of skin issues.

Individuals with atopic dermatitis frequently experience excessive skin dryness due to its inability to retain moisture. This lack of moisture can increase sensitivity and a heightened reaction to certain substances, compounds, or objects that trigger inflammation, resulting in itchiness and discomfort.

Atopic dermatitis is believed to be influenced by genetic factors. Your likelihood of developing atopic dermatitis may increase due to the genetic inheritance from your parents. Studies have demonstrated that children with a parent or both parents affected by atopic dermatitis or siblings with the same condition have a higher likelihood of developing atopic dermatitis themselves compared to children without a family history of the disease.

Various factors can elicit the symptoms of atopic dermatitis, and these triggers can differ across individuals. Some examples include:

• Excessive duration of hot showering
• Subjected to scratch
• Perspiration 
• High temperature
• Chilly and arid climate
• Hygiene products, detergents, and cleaning substances
• Wool and synthetic fabrics
• Particulate matter such as dust, sand, and cigarette smoke
• Pollen and animal hair
• Intense physical activity
• Stress
• Fragrances, skincare products, and cosmetics
• Hormone
• Certain foods, typically eggs, dairy products, wheat, soy, and nuts, 

Risk factor

Several factors that can elevate the susceptibility to atopic dermatitis include:

1. History of allergies

A personal or family history of allergies (such as atopic dermatitis or asthma) is the primary risk factor for developing atopic dermatitis.

2. Age

Atopic dermatitis typically manifests in childhood, however it can occur at any stage of life.

3. Sex

 Women exhibit a higher prevalence of atopic dermatitis compared to men.

4. Ethnicity

African Americans are more susceptible to atopic dermatitis. 

Symptoms

The onset of atopic dermatitis symptoms typically occurs before the age of 5 and can continue into adolescence and adulthood. Symptoms may occasionally manifest intermittently and subside for a while, possibly spanning several years.

Symptoms and signs of this condition differ widely among individuals. The primary symptom of atopic dermatitis is dry, pruritic skin that frequently changes into reddish lesions during exacerbations. Skin inflammation results in increased blood circulation and a strong inclination to scratch. While scratching may offer brief relief, it can exacerbate inflammation and increase the likelihood of skin infections.

Atopic dermatitis presents with varying symptoms according to age, and may include:

Symptoms observed in infants

• Dehydrated, irritated, and flaky skin
• Rash on the scalp or cheeks
• Lesions that may swell with discharge of clear fluid
• Infants may experience difficulty sleeping due to itchy skin
• Infants might also suffer from skin infections as a result of scratching 

Symptoms observed in children

• Lesions on the elbows, knees, or both
• Scaly patches in the surrounding skin
• Hypopigmented or hyperpigmented skin patches
• Thick and rough skin
• The skin is dehydrated and scaly
• Eruption on the neck and face, particularly around the eyes

Symptoms observed in adult

• Severely dry and flaky skin 
• Prone to itching
• The rash manifests on the back side of the knees, the crook of the elbow, the back of the neck, the face, and the periorbital region
• Adults with a history of atopic dermatitis since childhood may have patches of discolored skin that are rough and prone to irritation 

Diagnosis

Medical interview

In establishing the diagnosis of atopic dermatitis, the doctor will conduct a medical interview with you. The physician will inquire about various matters related to your condition, including:

• The symptoms you are currently experiencing
• The duration of these symptoms
• Rash location 
• Prior history of similar symptoms
• Personal or familial history of allergies
• Potential triggers for atopic dermatitis symptoms

Skin examination

The physician will subsequently do a physical examination by closely inspecting the lesions using a magnifying lens and light. Evaluating the condition of your skin, together with a comprehensive assessment of your overall health and the specific symptoms you are encountering, typically suffices to establish a diagnosis of atopic dermatitis. On certain occasions, the physician may additionally do other diagnostic tests, such as:

• Skin biopsy

During the procedure, the doctor anesthetizes the surrounding area of the skin from which samples will be extracted. Subsequently, the physician extracts a small skin sample to be examined under a microscope.

• Skin allergy test

This evaluation can assist in determining whether your rash is a result of an allergic reaction to a substance you came into contact with. Some specific plasters containing small allergens will be applied to your skin for a few days. Approximately 48 hours following the removal of the plasters, your physician will assess whether you have developed skin rashes in the area where the plaster was applied. 

Management

While atopic dermatitis cannot be fully healed, it can alleviate the symptoms and avoid future occurrences. Determine the specific factors that can elicit or exacerbate your symptoms, to evade them. The objective of atopic dermatitis treatment is to alleviate pruritus and discomfort, as well as to avoid infection and recurrence.

Here are a few actions you can take into account:

• If you get dry skin due to low humidity, consider utilizing a humidifier
• Hydrate your skin by applying a cream or ointment multiple times throughout the day, including after bathing
• Use warm water (avoid excessive heat) for bathing
• Use soap and other products free of fragrances, dyes, and alcohol
• Use skincare products that contain ceramide, since this moisturizer has the potential to improve the skin barrier
• Commit to the specified medication plan provided by your doctor consistently
• If you are experiencing stress or symptoms of mental/emotional disorders that may trigger atopic dermatitis, it is advisable to seek the guidance of a psychiatrist
• Phototherapy uses ultraviolet light, often ultraviolet B (UVB), emitted by a specialized lamp

Complications

Possible complications of atopic dermatitis may include:

1. Asthma

Atopic dermatitis can occasionally occur before the onset of asthma. Over 50% of young children diagnosed with atopic dermatitis could develop asthma by the time they are 13 years old.

2. Chronic itchiness and scaly skin

Itchy skin rashes will incite a desire to rub or scratch them vigorously. Chronic and repetitive scratching can lead to the skin developing discoloration, thickening, and roughness.

3. Skin infections

Continuous scratching can lead to the formation of open sores and cracks in the skin, elevating the susceptibility to bacterial and viral infections.

4. Irritant contact dermatitis affecting the hands

The condition primarily affects individuals whose occupations include frequent exposure of their hands to wetness and harsh substances such as soaps, detergents, and disinfectants.

5. Allergic contact dermatitis 

This type of skin inflammation is caused by an allergic reaction, which occurs when the skin comes into contact with reactive chemicals in an object, leading to an allergic reaction.

6. Sleep disorders

Pruritus can lead to diminished sleep quality.

Prevention

There are several things you can take to prevent this condition from coming back, including:

1. Refrain from using objects that may cause a triggered allergic response

Determine the underlying causes of symptoms and try to avoid those triggers. If a specific soap or cloth triggers a rash, discontinue its use. Avoid exposure to cigarette smoke, animal dander, and pollen if they exacerbate your skin condition.

2. Retain skin hydration

The optimal choice is to utilize a cream or ointment with a small water content. Apply it to your skin promptly after showering or when it is still damp.

3. Limit the duration of your showers

Limit the duration of your shower to 10 minutes and use warm water instead of hot water. After your shower, use a towel to dry your skin and promptly apply moisturizer.

4. Use gentle soaps

Use soaps that have soothing and non-irritating components for your skin. Antibacterial soap contains components that have the potential to dry out your skin. 

When to see a doctor?

It is advisable to get medical advice from a doctor if you or your child exhibit symptoms indicative of atopic dermatitis, to receive an accurate diagnosis and appropriate therapy.

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