Atopic dermatitis is a long-term skin condition. In simple term it’s itchy skin. It is more common in babies and children, but can also occurs in adults. It usually first appears between ages 3 to 6 months. The word ‘atopy’ comes from the Greek word meaning ‘without place, unusual, described by Coca and Cooke in 1923.
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Atopic dermatitis- inflammation of the skin due to allergies.
Atopic- having allergic tendencies
Non atopic-not having allergic tendencies
Age of onset- 60% develops in 2 months to 1 year of life. 30% are seen for the first time by age 5 years and 10% develops between 6 months to 20 years of age.
Slightly more common in males then females
Etiology-
• Clinical factors- like Xerosis means reduced water content of skin and decreased secretion of sebum and sweat. Dry and sensitivity means loss of epidermal barrier and irritation from wool clothes, soaps etc., stress, extreme weathers
• Immunological factors
• Genetic link (autosomal dominant) If one parent has then chances are 20% and if both have then chances are 50%
Clinical features:
• Dry skin
• Itching
• Red and brownish gray patches, especially on the hands, feet, ankles, writs, neck, upper chest, eyelids, inside the bend of the elbows and knees and infants face and scalp
• Thickened, cracked, scaly skin
• Raw, sensitive, swollen skin from scratching
Diagnosis-
Its clinical but lab tests help to rule out allergies.
• Allergy testing
• CBC
• Serum IgE
Management-
• Goal of therapy is to control inflammation, pruritus and secondary infection
• There is no 100% cure
• Use emollient regimes as first line of treatment
• Identification of triggering factors like irritants and allergens as second line of treatment
• Treatment of flares is 3rd line of treatment
Treatment points-
• Avoid aggravating factors
• Avoid coarse or irritating clothing
• Avoid both extreme of temperatures
• Use less of soap and use gentle soaps
• Bath (shorter) and emollients (apply twice daily atleast)
• Topical corticosteroids (advised by your doctor)
• Relief of pruritus
• Treatment of secondary infection
• Treatment of refractory cases
Why has the prevalence increased?
We have exposed our skin to more soaps and surfactants such as bubble baths to wash babies
• Soaps and surfactants increases skin pH
• Increase activity of protease
• Greater breakdown of skin barrier
• Increase penetration of irritants and allergens
Regardless the classification it is thought that the primary problem is the skin barrier
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