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 that 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 – woolen clothes 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, noncurable 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:

  • Narrowband 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 emphasize that long term preventative measures are necessary for 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.