Atopic dermatitis, what is it and what are the signs?

ATOPIC DERMATITIS, WHAT IS IT AND WHAT ARE THE SIGNS?

20-03-2017

Dra. Laura Miguel.

Parents often know that their child is atopic even before they go to the dermatology clinic because it is a common condition amongst babies and children and is easily recognisable. It can also affect adults, and in these cases it is more serious and quite resistant to the treatments available. Below we’re going to answer a few of the questions that often come up when talking about atopic dermatitis.

What is atopic dermatitis?

Atopic dermatitis is the most common chronic inflammatory skin condition that causes skin lesions on the face and body of babies, children and adults. It has been found that in rural areas and in families with lower incomes this condition is less common than in urban areas; This point has been discussed in detail as there is a hypothesis that greater hygiene during childhood and therefore less exposure to infectious agents can increase susceptibility to allergic conditions. Other factors are also relevant which we will explain later.

Who does it affect?

This condition affects around 10-30% of babies and children and between 2-10% of adults, which is a significant increase compared to 30 years ago.

What causes it?

In patients with atopic dermatitis the proteins responsible for keeping the structure of the skin intact are damaged, and as a result of this there is an imbalance in one of their principal functions which is the protection and barrier mechanism that guards against infections, irritants, environmental conditions, etc. The exact cause producing this mechanism is not known, but we do know that there are a series of predisposing factors such as:

  • Genetic factors: there is a common genetic base that links atopic dermatitis with greater susceptibility to asthmatic processes and allergic rhinoconjunctivitis.
  • Environmental factors: geographical areas with greater levels of dryness and low temperatures, as well as environmental pollution, lead to a greater probability of being affected by this condition.

What is the course of the condition and what are the symptoms?

The conditions comes and goes in outbreaks and there is no cure as such, although over time these outbreaks tend to become more spaced out until reaching a point where the dermatitis is stabilised. However, when the condition affects adults the symptoms are more severe.

The skin inflammatory lesions typically affect:

  • folds of the skin (the front of the elbows and behind the knees)
  • cheeks
  • back
  • abdomen.

The appearance includes:

  • red, flaky patches
  • scabs
  • abrasions
  • whitish or depigmented areas

The main symptom is intense itching of the lesions.

What can be done to prevent it?

The following factors should be avoided as much as possible:

Aggravating factors:

  • Allergic substances (pollen, dust mites…)
  • Excessive sweating
  • Wool and thick clothing
  • Smoking
  • Stress
  • Skin dryness
  • Long baths

What types are there?

Depending on the age of the person affected, the condition can be classed in the following groups:

  • Nursing infant atopic dermatitis: this appears in babies in their first few months of life. It mainly affects the face and folds of skin. The intense itching means that the infant is constantly irritated.
  • Childhood atopic dermatitis: this usually starts in children around two years old and lasts until puberty. The elbows and knees are usually affected. Scabs in accessible areas caused by scratching are very common.
  • Adult atopic dermatitis: this occurs after puberty and because of the constant inflammation the areas of skin affected swell up with rough, shiny whitish blisters with superficial abrasions.

How is it diagnosed?

The typical distribution of the lesions and the intense itching they cause mean that the diagnosis is mainly clinical. It is necessary to check the patient’s medical record with their family and personal history of allergic processes and skin conditions.

Is there any treatment?

There are topical medicines like steroids which along with emollient creams can help to relieve the outbreak but there is no cure as such. In cases that are resistant to topical treatment, oral medicine is needed, which is normal for adult patients affected by this condition.

 

To sum up…

Atopic dermatitis is the most common chronic inflammatory skin condition that affects children and adults, although it is more severe in adults and more resistant to treatment. We can try to alleviate the aggravating factors with basic skin care (daily moisturizing, wearing cotton clothing, avoiding excessive seating…).