What is Atopic Dermatitis: It is a chronic inflammatory itchy skin disease, which occurs more frequently in children, but can occur in adults & follows a relapsing course. It is often associated with personal or family history of allergies, allergic rhinitis, asthma & elevated levels of serum IgE. In 20% of children affected with AD there is no family history of allergy.
“Eczema or dermatitis means inflammation of skin due to allergy where skin looks angry with redness, oozing, crusting, scaling, thickening & it is associated with itching”.
Atopic eczema or dermatitis is a special type of eczema. The word “atopic” means there is a tendency for excess inflammation in the skin, linings of the nose and lungs. This often runs in families with allergies such as hay fever (allergic rhinitis) and asthma, sensitive skin, or a history of atopic dermatitis.
AD is a common skin disease seen all over the world, with 10% of infants & 3% of total population getting affected.
Why do you get Atopic Dermatitis? : Exact cause is not known. AD is a hereditary disease, having a raised serum IgE level, with a defect in immune system & skin; leading to dry skin which itches easily & gets inflamed to minor allergic episodes.
When do you get Atopic Dermatitis? : It can occur at any age, but commonly seen in infants to young adults. It has 3 stages, infantile, childhood & adolescent or adult stage.
How does it appear? : AD appears as dry scaly rashes with intense itching. AD rashes come & go; they may get worse or better during certain seasons, or during the course of a day.
Infantile Eczema: It appears by 2nd month of infancy, with reddish rashes, oozing, and crusting, over face, scalp, & other parts of the body. These infants rub their head, cheeks, and other patches with a hand, a pillow, or anything within reach because of itch. Many babies improve before two years of age.
Childhood Eczema: Later on, by 2nd year, these rashes localize to face, behind ears, neck, armpits, bend of elbows, behind knees, wrist, ankles, as dark patches with redness, itching leading to thickening of skin. These rashes appear & disappear on & off lasting till the adolescence to early adulthood. Itching is intense especially at night. AD children (10-30%) can develop asthma or allergic rhinitis, at same time or one or both of these conditions may develop later.
Adolescent/Adult Eczema: Atopic Dermatitis improves with adolescence, but many patients are affected throughout life, although not as severely as in early childhood. It might localize to some areas like, back of neck, hands, behind knees, bend of elbows, ankles with oozing, crusting or thickening & darkening of skin. Sometimes it appears as widespread rashes with intense itching lasting for long period of time.
General information: It is not a contagious disease. It does not affect the health or growth of the child.
Atopic Dermatitis patients have a lifelong tendency to have:
Dry skin, hand eczemas, bacterial & viral infections of skin, eye lid dermatitis, cataracts, family/social relationship disrupted, work loss.
What are the Aggravating factors:
- I. Allergens like:
- Dust & Dust mites in carpets, stuffed toys, cotton pillow/mattress, cupboards.
- Dog & Cat dander, pollen, fungal mold
- Plants, perfumes, sometimes food-Rarely-10% (either by contact or by eating the food)
- II. Irritants like:
- Wool, nylon, acrylic & tight clothing. Acidic foods like tomatoes, citrus fruits-coming in contact with skin.
- Chemical in fabrics like colour dye, detergents, fabric softeners, dettol etc. Chemical in lotions, creams, Soaps & detergents etc
- Smokes including tobacco smoke, fumes, paint, polish, bleach.
III. Infections-viral, bacterial or fungal.
- Sudden change in temp, sweating-due to exercise
- Emotional stress
How long Atopic Dermatitis will continue:
Most (90%) of the Infantile & Childhood AD will subside by adolescence, some (10%) will continue AD with few rashes localized in some areas (hands, feet, elbows, back of knee) in adolescence & adults, few (1%) will have rash all over the body through out their life.
How to cure Atopic Dermatitis :
Even though there is no cure of AD, this disease can be controlled by prevention, medication, & careful adherence to a treatment program supervised by a skin specialist.
Treatment:
General:
AD patients suffer from dry skin. Because of this skin protection is lost; irritants & allergens can reach the sensitive layers below the skin thereby causing a flare up of AD.
Dry skin can be prevented by having a lengthy bath with Luke warm water by adding bath oil to the water. To use mild skin cleansers or neutral ph soaps. Wipe the skin with soft towel, not to scrub the skin with any abrasives like loofa, pumice stone etc. Skin can be kept soft by applying a simple moisturizing cream or Vaseline or oil immediately within 3 min after bath.
Atopic Dermatitis patient should avoid the aggravating factors.
Tips to stay away from Allergens:
If you are allergic to pets, stay away from them. However, if you have a pet in your house, it is advised that you clean your house often, give bath to dog once in a week, & keep your pet off your bed & other furniture you use.
If you are allergic to pollen, stay indoors as much as you can during allergy season. Keep windows closed & use a fan or air conditioner to keep cool instead. When outdoors, avoid playing on the grass, & bath before going to bed to rinse off any pollen that is clinging to your skin or hair.
If you are allergic to dust mites, you need special & suitable covers for your cotton mattress & pillow (best is to avoid cotton mattress & pillows) or use a foam or coir mattress. Avoid carpets. Vacuum clean your mattress & curtains regularly. Avoid stuffed toys or wash them with hot waters regularly as they are dust catchers. Vacuum clean your car & office, cupboards. Avoid using clothes which have been in the cupboard for long time as they catch dust & mold. Air those clothes in sun, or wash & Iron them before using.
If allergic to hair dye, avoid using all hair dye as most of them contain PPD. Use herbal dye without PPD. If allergic to nickel, avoid artificial & silver jewellery.
Tips to stay away from irritants:
Do not wear wool, polyster, nylon, or acyrlic clothes directly on the skin. First layer should be loose cotton clothes. Avoid clothes with rough seams or trims. Wash new clothes before wearing them in order to soften & to remove any chemicals on the fabric. Use dye-free & perfume free detergent for your clothes & rinse your clothes properly to remove any soap residue.
Avoid touching acidic foods ( such as tomatoes or citrus fruits) if they seem to trigger a rash. Wear rubber gloves with cotton lining inside while using cleaning products.
Avoid staying in an atmosphere of paint fumes & smokes (including cigarette, agarbathi, sambrani, mosquito repellant smoke, etc).
Avoid using perfumes & body sprays directly on skin. Avoid using balms, other irritants on skin. Avoid using dettol, after shave lotion.
Tips to help your skin adapt to temp changes:
Try to stay indoors during very hot or very cold weather whenever possible.
If sweat irritates your skin, avoid vigorous exercise, especially when your skin is flaring, avoid hot baths, going out in hot sun & emotional stimuli.
If you are active, wear cotton clothing that allows the skin to breathe & enables easy sweat evaporation.
After coming from school or from office, don’t change the clothes immediately, as sudden change of temp causes itching. Cool the body by resting & using the fan for few minutes then change your clothes.
Establish a skin care routine.
Recognize stressful situations & events.
Learn stress management techniques-meditation & yoga.
Be aware of scratching.
Control your environment.
AD patients can reduce scratching by habit reversal technique: Clench fist & count to 30 at any or all urges to scratch. Pinch or press nail into itch spot.
Follow up with: Distraction that keeps hands busy (eg: playing the piano). Be aware of scratch triggers (eg: heat, undressing) & prepare to reverse habit.
Use hand counter to clock “itches”.
In children, parent must make child aware of scratching & teach child to apply pressure.
Never say “stop scratching”
Praise the child’s habit reversal. Be with child continually the first 4 days of starting program.
Optimism & attention to every itch signal, conscious or unconscious, are necessary.
Itch is evanescent, but the scratch effect is long-lasting.
Specific:
Oral antibiotics to control flare ups & secondary infections, antihistamines for avoiding itching, sometimes for severe rashes a short course of oral steroids are given.
Oral immunosuppressants like cyclosporine or azathioprine are given for a short period. Narrow band UVB phototherapy is helpful in some.
Topical applications of corticosteroids creams/ointments are the main treatment.
Avoid overuse of steroid creams as it can lead to skin thinning, temporary whitening of skin etc.
Topical immunomodulators like tacrolimus & pimecrolimus are safe & helpful, with min side effects.
Website: www.nationaleczema.org