Atopic dermatitis (eczema endogenous) is one of the most common inflammatory diseases in childhood. We have observed an increase in the frequency of the disease during the last three decades. The most affected are children in infancy. The disease has a chronic course with periods of worsening, called exacerbations or flares, followed by improvements, called remissions. However, the disease has no significant impact on overall health.
Atopic dermatitis can occur in any age; most often it affects infants and young children. Up to 50 % of cases begin in the first year of life, 80% of patients with atopic dermatitis with time develop allergic rhinitis or asthma. Many children with atopic dermatitis enter into a permanent remission of the disease when they get older, although their skin may remain somewhat dry and easily irritated. There is a known hereditary predisposition of the disease and is the earliest occurring component of atopic disease in humans. Atopy is a special type of hypersensitivity is associated with asthma, inhalant allergies (hay fever), and a chronic dermatitis. Some other characteristics as constipation, headache, and typical emotional reactions of the affected individual may be observed.
What can trigger or worsen atopic dermatitis?
These factors are not yet fully understood. Undisputedly, there is a hereditary factor that determined the higher risk of atopic dermatitis in children whose parents suffer from the disease or have hay fever or asthma.The genetic changes in the affected individuals determine immunological defects that lead to defect formation of the lipids in the stratum corneum of the skin, resulting in dryness and lack of hydration.These factors determine the ease of penetration of multiple external irritants (allergens) that provoke the increased reactivity of the skin and the appearance of rashes on the surface. The most common triggers are soaps, solvents, wool and perfumes, house dust, pollen and some types of food (eggs, milk, strawberries, chocolate, fish, shellfish, peanuts and others). People with atopic dermatitis are particularly prone to skin infections with Staphylococcus aureus resulting in more frequent boils, folliculitis and infected eczema.
What are the symptoms of the disease?
The main signs of the atopic dermatitis are dry skin, intense itching and underlying skin reactivity to external factors already mentioned. These agents cause rashes, which are located on the face, neck and folding surfaces of the extremities. Itching continues throughout the day and becomes particularly intense in the evening hours of the day. Itching is the leading symptom of the disease. Skin changes can vary widely in atopic dermatitis and they should be determined by a dermatologist.There are some differences in the course of the disease in children. They depend mainly on the age of onset. The disease is more severe in the neonatal period and during the entire first year of a child's development. Most affected are the face, scalp, neck and outer surfaces of the extremities, rashes are often weeping, crusting and scaling. This form of eczema may disappear by the third year, but often becomes chronic and lasts into adolescence or adulthood. In adults, the disease tends to be chronic with development of few eruptions on the folding surfaces of the hands, feet and neck, and eyelids. In these areas redness, scaling and thickening of the skin are observed. In the later ongoing atopic dermatitis "dermatitis of the hand“ is common. It is characterized by redness, itching, scaling, and leading to increased skin relief of the palm. Another characteristic feature is the appearance of rashes on the skin - localized around the eyes and lips. These areas are covered by typical plaques of the disease with redness and scaling accompanied by intense itching. These changes are associated with the use of cosmetics or psychological stress. In many cases atopic dermatitis in adults occurs on the chest, back and neck. In these cases, the changes are usually provoked by undiagnosed infection with pityrosporum ovale - a type of fungus that leads to exacerbation of the dermatitis.
How is atopic dermatitis diagnosed?
The diagnosis is based on detailed conversation with the patient or with their parents about the clinical history, symptoms of the disease as well as a thorough clinical examination. Tests have little importance in diagnosis, but are important for the detection of complications. Therefore a consultation with a dermatologist is essential for the timely initiation of treatment and reducing the risk of complications.
What is the treatment?
Once atopic dermatitis is diagnosed, you should start the treatment, guided by an experienced specialist. It includes establishment of proper hygienic habits, a necessary diet, enough exercise, enough sleep and photoprotection.Among the most commonly used drugs are local anti- inflammatory agents from the groups of corticosteroids and calcineurin inhibitors. They reduce the risk of disease progression and reduce the spread of skin changes. In severely affected patients systemic treatment is needed. Systemic antibiotics control the bacterial infections, antifungal agents – the fungal infections. Systemic immunosuppressive agents are also used for more severe cases.There is a good respond of atopic dermatitis symptoms to phototherapy. The natural phototherapy is done by exposure of skin to controlled amount of sunlight. The therapy could be performed in clinics using artificial ultraviolet (UV) A and narrow band B UV-rays devices. These therapies could be combined with other medications.Using mild soaps is essential for the treatment of atopic dermatitis - they spare the protective barrier of the skin. The constant use of appropriate and non-irritating skin lubricants called emollients is important for maintenance of lipid barrier. They are applied not only during the flares, but constantly to prevent the occurrence of new exacerbations. In fact, constant hydration is considered to be the main prevention.
What is the course?
With majority of patients there is a tendency for spontaneous improvement. The disease can flare periodically and then subside at the 3rd and 7th year, and in the puberty. In 25 % of cases, however, atopic dermatitis is long-lasting. It is believed that the early age of onset of skin lesions, intense itching, the combination of skin changes with other atopic symptoms such as asthma and hay fever and frequent infections are symptoms that define more severe course of the disease. The features that define less severe course of atopic dermatitis and complications are late onset of skin changes, seasonal dependence and restriction of the spread of the lesions.