ATOPIC DERMATITIS

ATOPIC DERMATITIS. HOW TO PREVENT OUTBREAKS

18-11-2016

Dr. Gemma Márquez.

What is atopic dermatitis?

Atopic dermatitis is becoming increasingly common in children, affecting up to 20%. 2-5% of adults also suffer from it. This percentage has been seen to increase, especially in western countries. But luckily, for most children, it clears up by itself during adolescence.

How can I be sure it is an outbreak of atopic dermatitis?

There are other skin diseases that can be confused with atopic skin. The atopic patient displays two characteristics above all: very dry skin and very itchy skin.

Why? What causes it?

The causes of atopic dermatitis have been thoroughly researched and 4 essential factors have been found to be involved in its etiopathogenesis: genetic predisposition (if your mother had atopic dermatitis, you’re more likely to get it too), an immunity alteration, an epidermal barrier dysfunction and also environmental factors.

It is very important to point out that atopic dermatitis can severely affect the quality of life of patient’s and also their families, especially in the most severe cases.

Atopic skin often displays what we call an “outbreak of atopic skin” which is a phase in which the patient’s condition deteriorates and the itching, discomfort, skin dryness, sores from scratching, etc… all get worse.

How to treat these outbreaks

At the moment there is no definitive cure. And that’s why it is so important to follow a series of care steps in order to control the condition, and thereby minimise the number and severity of the outbreaks:

  • HYGIENE: prolonged baths, with very hot water and aggressive soaps can increase xerosis (dry skin) and can make atopic dermatitis worse. Short baths are advisable, with warm water, using mild soaps without detergents and soaping the body with the hand rather than using rough sponges. When an outbreak occurs, there are oils available at the pharmacy that can relieve the condition.
  • MOISTURISE: the skin needs to be moisturised, a lot. At least once a day and after a bath if possible, as that is the best time. It is better to use creams rather than oils. A lot of parents or patients say that when an outbreak occurs, the skin itches when the cream is applied, and in these cases medical treatment is needed and then you can go back to the moisturising cream when the skin is better. The cream shouldn’t only be used when the skin is dry, it is important to understand that the cream should be used always, to improve the skin’s barrier function and to prevent outbreaks of atopic dermatitis.
  • ENVIRONMENTAL FACTORS: environmental dryness increases itching. Hot air based heating systems can be an aggravating factor, and the use of humidifiers, although not recommended for continuous use, can be beneficial.
  • SUN: patients with atopic dermatitis are recommended to use physical photoprotectors, because as their skin’s barrier is altered they may be sensitive to some chemical elements contained in sun creams. Additionally, exposure to the sun may be beneficial for atopic dermatitis. However, with children you need to follow the correct photoprotection measures and in particular children under 6 months old should not be directly exposed to the sun.
  • CLOTHES: it is advisable to wear cotton garments, avoiding lycra, wool, rubber… In summer some patient’s find that sweating can aggravate their atopic dermatitis and itching, so it is important to make sure that children do not wear too many clothes that could make them too hot.
  • DIET: In general dermatologists do not recommend any type of restrictive diet, unless of course the child is known to be allergic to a particular food and each case needs to be assessed on an individual basis.
  • VACCINES: The vaccine schedule should be followed just the same as for all other children. If the child is being treated with oral steroids or some topical treatments (tacrolimus, pimecrolimus) simultaneous live virus vaccinations should be avoided (varicella, rubeola, measles, parotiditis and poliomyelitis).

In short, the most important thing is to correctly diagnose atopic dermatitis and then prescribe the right treatment and a series of skin care tips so that patients with atopic dermatitis can improve their condition and their quality of life, which is often affected by this disease.