Atopic dermatitis

Atopic dermatitis is a common inflammatory skin disease that develops in the early childhood characterised by severe itching and dryness of the skin and chronic eczema — inflammatory lesions.

Why does atopic dermatitis develop?

It is believed that atopic dermatitis develops due to a genetic predisposition in junction with other factors. Atopic dermatitis is usually associated with other atopic conditions such as allergic rhino-conjunctivitis, food allergy and asthma. At the base of this condition is a disruption of the barrier function of the skin, resulting in increased water loss and facilitated access of irritants, allergens and microorganisms through the skin, which stimulates the inflammatory process characterised by severe itching and redness. In addition, people with atopic dermatitis have a higher amount of pathogenic bacteria such as Staphylococcus aureus compared to other bacteria, viruses and fungi that are normally found on the human skin.

Factors that can exacerbate atopic dermatitis

* Climate — very high or low temperature and low humidity * Irritants — woolen materials, detergents, softeners, fragrances * Skin infections — Staphylococcus aureus, Herpes simplex virus, Molluscum contagiosum or systemic infections * Allergens from the environment — pollen of weeds and trees, mites and dust, contact allergens * Food allergens — most often eggs, milk, peanuts, nuts, fish, soy and wheat. Ovi alergeni pogoršavaju AD kod malog broja osoba koje imaju jak oblik bolesti.

What skin changes are characteristic of atopic dermatitis?

Most people with atopic dermatitis have constantly dry and sensitive skin with a more or less pronounced itching sensation. Clinical picture depends on age. * In children up to 2 years of age — the first changes may occur after the age of 2 months in a form of red hot spots that are moist and swollen, with or without crusts on the cheeks, forehead, head, neck, trunk and extensor surfaces of hands and feet. The diaper area is usually spared. Intense itching is present, which is why children are often nervous, sleep deprived and scratch heavily, further irritating the skin. * In older children (from 2 to 12 years) — in addition to the itching, a dry, red changes with scaling or thickened skin on the back of the elbows and knees, wrists, fists, feet, neck and around the eyes are also present. * In adolescents and adults (12 years and older) —dry and thickened lesions (lichenified) are present as a result of skin inflammation and scratching on the skin-fold areas (elbows and knees). Adults with atopic dermatitis can only have hand dermatitis or face eczema, especially around the eyes, that exacerbate under the influence of various external irritants. Chronic eczematous changes often develop around the breast nipples. * In the elderly (60 years and older) — AD is characterized by severe skin dryness and often itching with thickened patches on the skin. Atopic dermatitis has an important effect on the quality of life of both the child and the family. Significant itching affects the child’s sleep disorder, increased irritability, and therefore can trigger the exacerbation of itching, scratching and intensification of skin changes, and also the development of an infection. Pityriasis alba is often seen in children with atopic dermatitis and develops as a result of eczematous dermatitis of mild intensity, resulting in hypopigmented whitish areas with tiny scales on the face.

What are the most common complications?

Infections — bacterial and viral infections are the most common complication of atopic dermatitis. Staphylococcus aureus and Streptococcus pyogenes are the most common causative pathogens of skin infections in people with atopic dermatitis, which is manifested by moist lesions with yellowish crusts, as well as the exacerbation of the underlying disease. Eczema herpeticum is caused by a Herpes simplex viral infection on the skin in people with atopic dermatitis. Initially, widespread tiny vesicles are observed, most often on the head, neck and trunk, which progress to erosions and crusts. This disease is accompanied by high fever, malaise and swollen lymph glands, and bacterial infection, viral keratoconjunctivitis or meningoencephalitis can develop as a complication.

How do we make a diagnosis of atopic dermatitis?

There are a number of criteria on the basis of which it is possible to make a diagnosis of atopic dermatitis. In most cases, the diagnosis is made based on itching, dry skin, eczematous lesions that have a specific distribution on the body depending on the person’s age, of the early appearance of skin lesions, the chronic course of the disease with the stages of improvement and exacerbation, and the presence of a personal or family history of atopy.

How is atopic dermatitis treated?

In the atopic dermatitis therapy, the prevention is very important, to prevent exacerbation of the disease and the development of acute inflammatory changes, and active treatment in the stage of acute changes. Preventive measures include adequate education of patients and parents, regular use of moisturising creams, use of mild hygiene products. Showering is essential for patients with atopic dermatitis because is removes impurities and sweat from the skin, but at the same time it is necessary to take care not to dry out the skin. That is why it is recommended to take a shower with lukewarm water for 5 to 10 minutes and to use pH5 syndets or oil baths. Immediately after showering, emollients should be applied to the skin. If corticosteroid creams or other topical preparations are used for the treatment of atopic dermatitis, they should be applied first, and only after a few minutes other moisturising products. The use of emollients is important because they hydrate the skin, restore its barrier function, and therefore the water loss through the skin is reduced and resistance to external irritants and microorganisms is increased. This prevents the development of fresh eczema changes and reduces itching. It is very important that emollients have been dermatologically tested and that they do not contain substances that could act as allergens or irritants. In addition, it is recommended to use periodically probiotics, vitamin D and zinc in preventive purposes.
Svetlana Đurišić specijalista dermatovenerologije

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