ATOPIC DERMATITIS


What is Atopic Dermatitis?


Atopic dermatitis is also referred to as ECZEMA. It is a genetic skin disorder characterised by a defect in the skin barrier. As a result, there is an increase in the amount of water loss from the skin surface. The skin becomes hypersensitive and allergic to a wide variety of substances. This condition presents with extremely itchy skin and a rash which has a predeliction for the face and flexures - elbows/knees. In severe cases, the condition may be widespread to affect the entire body. Most patients have a positive family history of other forms of allergy - asthma and hayfever.  
What is the presentation of the rash in this condition?


The condition usually starts in infancy from the age of 3 months onwards with itching, irritability and scaling of the face, scalp and trunk. In older children, the elbow and knee flexures are the main sites of involvement. In severe cases, there may be extensive involvement of the limbs and trunk with itching, scaling, excoriations and secondary infection. Dryness of the skin is a common feature.


What are the triggering factors? 


The triggering factors include the following: 
 
Climate change- extreme heat/cold may worsen this condition
An allergic predisposition
Viral infections
Exercise/ stressful conditions
Diet: foods and drinks with preservatives
Clothing – woollen cloths may trigger a flare of this condition
What is the treatment?


It is important to realize from the outset that Atopic Dermatitis is a chronic, non curable condition, and that treatment at present is aimed at controlling the symptoms.


The treatment options include the following: 

 

Hypoallergenic soaps/moisturisers
Bath emollients
Topical steroids/oral pulse steroids
Oral antihistamines
Topical/ oral antibiotics
Topical Tacrolimus(Protopic)- for moderate to severe eczema
Pimecrimus(Elidel)-for mild to moderate eczema


For very severe cases, one may consider the following: 

 
Narrow band UVB/PUVA therapy
Azathioprine
Methotrexate
Cyclosporine
Mycophenolate Mofetil (Cellcept)


It is important to take note that the above measures are useful in controlling acute flare-ups of the disease. However, it is important to emphasise that long term preventative measures are necessary in the management of this condition.


What is the long term outlook in this condition? 

 

The condition usually remits spontaneously in early childhood. If the condition persists into adolescence and adulthood, it will then enter the chronic phase characterised by intermittent exacerbations with thickening of the skin folds.