Atopic dermatitis is what sometimes other people call as “skin allergy”. It is a recurring, distinctive cutaneous inflammatory condition with strong genetic predisposition. The skin lesion can start as early as infancy and progress to childhood and adolescence. It has a relapsing course and patients with atopic dermatitis are also at risk for developing allergic rhinitis and asthma.
Just like allergic rhinitis and asthma, this type of dermatitis can be triggered by ingestion of food allergen and inhalation of inhalant allergens such as house dust mite, mold and pollen. It can also be initiated by coarse clothing and emotional stress.
Atopic dermatitis has 3 distinct stages, each with fairly characteristics features based on the age of the patient.
The first stage is the infantile stage which commonly begins during the 4th to 6th month. It presents as itchy, red rashes on the cheeks that spreads to the forehead, back of the arms, and anterior surface of the legs. Heavy scaling of the scalp is prominent. However, the skin around the mouth and eyelids are usually spared.
Between 2 and 4 years old, childhood stage gradually occurs and may follow the infantile stage, or it may appear several years later. Skin lesions are characterized as itchy, excoriated papules (small solid elevations on the skin with less than 1 cm diameter) on the face, anterior surface of the arms, and back of the legs. Due to persistent irritation produced by scratching or rubbing off of these itchy lesions, the skin becomes hardened and leathery (known as lichenification). The patient also assumes the so-called “mask of atopic dermatitis” where there is whitish hue of the face. This stage may disappear before 10 years of age or continue into adulthood.
The adult stage of atopic dermatitis has the same characteristic skin lesions in childhood stage, but this time it involves the dorsal aspect of the hand and the upper eyelids.
Management of atopic dermatitis embraces two basic principles: (1) avoidance of environmental factors that may potentiate the itch-scratch cycle, and (2) good skin hydration in any stage of the illness. Here are some helpful tips that need special consideration.
1. Avoid the following: -food allergens such as peanuts, eggs, milk, seafoods
-inhalants (house dust mites, molds)
-extreme change of temperature and humidity (This will lead to
sweating and aggravate itching.)
2. Physical irritants such as soaps, detergents, wool, silk, nylon, and other synthetic
fabrics should also be avoided.
3. Hydrate the skin by bathing or soaking the affected area in tepid water for a period of
15 minutes 2-3 times per day. After the bath, remove excess water by patting with
soft towel. Then, apply appropriate topical steroid medication within 3-5 minutes.
Such immediate application will prevent evaporation and dryness of the skin,
providing the advantage of increasing the penetration of the topical medication.
4. Moisturizers in lotions or creams can also be applied 3-4 times daily, immediately
after baths to add some moisture to the skin.
5. When used with hydration, occlusives like petroleum jelly or vegetable shortening
are effective in dry environments as they allow less evaporation.
6. Suspect secondary bacterial infections in the presence of acute weeping or cracking
lesions. It is best to consult a physician as this will need antibiotic therapy.
Just like other long standing recurring diseases, patients with atopic dermatitis need psychological support and education. Most of all, patients and parents need to be assured that the disease can be controlled, and that majority improve with age.