Everything you need to know about atopic dermatitis or eczema

10-30 percent of the babies and children suffer from the atopic dermatitis across the world. This condition is very common in children below 5 years of age.

Here we try to explain how this affects your children and what are the treatment options for that. It will help you to know more about this condition and will help you to solve your queries.

What are the symptoms of atopic dermatitis or eczema?

Atopic dermatitis (AD), or eczema, is the most common chronic relapsing skin disease seen in infancy and childhood.

Those who have atopic dermatitis are likely to show symptoms in the first year of life. 50 percent are diagnosed within 1 year of birth and remaining are diagnosed between 1 -5 years of life.

The symptoms can occur in waxing and waning courses or can remain constantly affecting the child. Most commonly they are waxing and waning, for some days they will become severe and for some days may decrease in intensity.

If your child has this condition he/she is likely to suffer from pruritus. Pruritus is itching of the skin. This itching is typically increased at night.

The child becomes irritable and the sleep is disturbed, and starts crying in the night.

Infants more than 4-6 months old try to scratch the itchy area and it may cause excoriation and oozing of blood from the local area.

You can notice the redness of skin where there is intense pruritus that is itching of the skin. 

The face and extensor surface of the area is affected more commonly and diaper area is spared in this condition.

In this process with severity the outermost superficial layer of the skin may look scaly and may fall off with itching. The skin looks dry and red with marks of excoriation i.e. scratches.

With repeated increasing and decreasing intensity of the condition the skin may become dark and dry. This indicates that the child has suffered many such episodes and the problem is chronic.

Acute atopic dermatitis

In acute problems the child has intense itching on skin with small papules in the area of itching. There is redness of the skin in the affected area. There are scratch marks in the affected area.

Usually the face and extensor surfaces of the limbs are involved.

Subacute atopic dermatitis

In subacute condition there is erythema and scratch marks and also there is appearance of scales in the local area.

Chronic atopic dermatitis

When the condition becomes chronic the scales appear on skin become thick with discoloration and dryness of the skin. Usually the flexural areas of the limb are involved.

If your child has chronic conditions all the stages may appear in different parts of the body.

Usually with the edge the symptomatic intensity is reduced but adolescents and adults with this history are likely to suffer itching and dermatitis occasionally intermittently.

Is it associated with other atopies?

Yes it is. If the family has a tendency of allergic disorders the frequency of atopic dermatitis increases in infants and children.

Other family members may be suffering from conditions:

Those children who were suffering from atopic dermatitis in young age may suffer from these above conditions in the future. This progression from one condition to another is an ‘allergic march’.

Which are the factors that trigger Atopic dermatitis?

One or more of the following factors may trigger the atopic dermatitis or make it worse affecting the children.

There is extensive list of factors that can trigger atopic dermatitis and some of the common are as follows:

Foods

  • cow milk
  • Egg
  • Peanut
  • tree nuts
  • Soy
  • Wheat
  • fish, shellfish

Particles

  • Pollen
  • Grass
  • animal dander
  • dust mites

infection 

  • Staphylococcus
  • herpes simplex
  • Molluscum

Environmental conditions

  • reduced humidity
  • excessive sweating

irritants 

  • Wool
  • Soaps
  • Toiletries
  • Fragrances,
  • Detergents

If one or few are affecting the child it can be identified in history. Usually many of these factors affect a child at the same time.

Why atopic dermatitis?

There is still a detailed ongoing research across the world on atopic dermatitis. Let us try to explain it in simple words.

There are two types of atopic dermatitis and they are IgE mediated and non-IgE mediated allergic dermatitis depending on the mechanism. 

In both types of atopic dermatitis there increased eosinophil counts in the baby when the blood is tested.

In both these types the protein structure in skin is slightly changed and the skin is infiltrated with lymphocytes. Lymphocytes are antibodies producing cells, an important part of the immunity.

In acute atopic dermatitis the lymphocytes and neutrophils get attracted to the skin layer causing local inflammation and local symptoms. In chronic lesions these cells are replaced by monocytes and causing hardening and drying and darkening of the skin.

Due to all this process in simple words there is local swelling, redness and irritation at the affected site of the skin.

What are tests which diagnose atopic dermatitis?

Diagnosis is usually made by typical clinical presentation of acute symptoms occurring repeatedly and after some months chronic symptoms of the conditions.

These symptoms associated with family history of allergic rhinitis and asthma and food allergy are supportive findings which make diagnosis highly likely.

There are no tests which are confirmatory for the atopic dermatitis but the tests may be required for differentiating the other conditions.

What is treatment of Atopic dermatitis?

To treat the atopic dermatitis the goal of treatment is relief from the symptoms and also avoiding the repeated episodes in the children.

Following are the important steps that are useful to treat the atopic dermatitis.

Maintaining the Skin hydration

In atopic dermatitis there is dryness and scaling of the skin. This dryness and scaling of the skin causes reduction in lipids in the layer of the skin. This makes skin likely to lose the water and also the barrier function of the skin is reduced, making it exposed to the various kinds of infections.

To maintain skin hydration, following are the tricks:

  • Soaking bath with lukewarm water.
  • Creams that moisten the skin such as moisturizers and occlusive ointments and emollients. These are usually available on prescription and generally advised to use after bath to retain moisture. Occlusive ointment may block the sweat gland and may harm some people. Use these medications with medical advice and monitoring by a dermatologist or pediatrician.
  • Wet dressings at the local area help to hold the moisture. Additionally local dressing helps to reduce the scratching efforts and there is good absorption of the glucocorticoids with wet dressing. But wet dressing may themselves cause local infection and maceration so should be done under medical observation.

Local glucocorticoids

Local corticosteroid application is the mainstay of the therapy. Depending on severity of the condition mild to most potent glucocorticoids can be used. These can be harmful if used incorrectly. 

Those should be used with medical advice only. Depending on severity, potent glucocorticoids used initially may be switched to less potent glucocorticoids later on.

Antihistamines

These have limited role to play in atopic dermatitis. They help to reduce the itching. Antihistamines like hydroxyzine and promethazine have sedating effects so are better to control the night time severe symptoms. Though antihistamine will not cure the condition it helps to reduce the symptoms.

Topical calcineurin inhibitors

Topical calcineurin inhibitors are useful when the topical steroids are not effective or cannot be used.

For mild cases pimecrolimus and for severe cases tacrolimus cream is useful. These care useful on the face and neck where potent topical steroids are not useful.

These medicines help to reduce the inflammation in skin where topical steroids fail. Calcineurin inhibitors are better than topical steroids for many patients.

These are available on prescription only and do not use without medical advice.

Tar preparation

Topical tar preparations are for this condition to reduce the skin inflammation. These are usually less effective than calcineurin and topical corticosteroids. Tar preparations help to reduce the potency of the glucocorticoids used locally.

Systemic corticosteroids

Systemic corticosteroids help to control the acute episodes of atopic dermatitis. Do not stop them abruptly or they cause more severe rebound of symptoms after stopping the drug. Medical practitioners use these as short courses with tapering doses for many days after control, till the other skin care therapy is well in place.

Cyclosporine

Give cyclosporine when other therapies fail. It is given orally or by injection then continued orally in small doses till 1 year. 

Antimetabolites

Antimetabolites like methotrexate and azathioprine are last resort for the treatment.

Phototherapy

Natural sunlight is the best till you prevent sunburn. Other therapies include 

  • Ultraviolet A-1
  • Ultraviolet B
  • Narrow band ultraviolet B
  • Psoralen plus ultraviolet A

How to prevent Atopic dermatitis?

There are many triggers for atopic dermatitis listed above and avoiding those factors is the best strategy to control the episodes and severity of the atopic dermatitis

The principals we explained earlier about ‘how to prevent allergy? are applicable here also.

Avoid readymade food and formulas

Avoid readymade food and formulas and prefer homemade food as much as possible. For a change once in a month or 2 months readymade food is ok but not more than that. Anyway if you want children to follow your orders you need to respect their opinions too. Give them the condition that if they properly eat homemade food for a month then only will get outside food at the end of the month. Well, win-win situation for both.

Exclusive breastfeeding

Exclusive breastfeeding till 6 months of age help to protect infants from developing various kinds of allergies. It helps to prevent allergy in future. Continue exclusive breastfeeding till 6 months as best food for the infants. Nothing other than breast milk and needed medicines are to be given to infants till 6 months of age. 

Colouring agents

Avoiding food containing coloring agents helps to prevent allergy. Food bakery products chocolates, cakes, biscuits, often contain coloring agents leading to allergies so better avoid them. Eat home made snacks of idli, dosa, uttapam, usal, poha, upma, paratha rather than those bakery products.

Fresh fruits

Preferably bring fruits raw and let them ripe in house. Avoid carbide and chemicals ripened fruits. These chemicals are dangerous to health and cause a variety of allergic conditions and other health effects that are not desirable.

Preserve fruits and vegetables at room temperature and consume fresh rather than storing in the fridge and eating cold food. Cold food and cold exposure causes an array of allergic manifestations ranging from allergic rhinitis to acute attack of asthma. Various skin allergies increase in winter seasons too. 

Avoid smoking

Strictly avoid smoking at least in homes where small children and older adults live. Smoking is injurious to yourself inducing allergies as well as it is injurious to those around you posing them to increased risks of cancer and various kinds of allergies. Smoking should be strictly stopped if you are pregnant as it may seriously affect you and your baby.

Pest control

Pest control measures other than chemical pesticides. It is good as pests themselves cause allergies in a variety of ways. But if you are using chemicals and gases to control them it is equally harmful and dangerous to you and people around you as chemical pesticides can have serious effects on you especially lasting long term. These chemicals may induce allergies by themselves as well and they have the capacity to stay for a prolonged period in the environment.

Avoid pollutants

Stay away from construction sites and where the pollutants levels are high. You inhale soil and cement particles near construction site causing symptoms from allergic rhinitis to acute attack of asthma. Those who have allergic tendencies better stay away from the construction site. Additionally at construction sites a specific type of fungus grows that is responsible to induce allergies and severe fungal lung infection in immune-compromised hosts.

Avoid burning dhoops and agarbattis in the house at least when a person with allergic tendencies is in the house. 

Avoid strong smells

Stop using strong smells and scents and perfumes as these may induce allergies if you are prone for the allergy.

Stop using talcum powder

Avoid using talcum powder as it may float in the air in the form of particles and can get into your nose and lungs while breathing can lead to the allergic rhinitis and cough.

Stop giving soft toys to children

Avoid giving soft toys to children or cover them with some plastic. These soft toys can gather a lot of dust in them and while playing children may inhale that dust into the nose causing allergic rhinitis and cough.

Wash curtains

Every house has curtains in it. These curtains are very good at attracting the soil particles on them. When you move curtains or children are playing with them the particles on them can cause allergic rhinitis and cough. Wash the curtains once in a week or two with warm water.

Cover the beddings and pillows

Cover the beddings and pillow some kind of plastic covering that doesn’t allow the particles inside to fly as those particles can rhinitis and cough when someone sleeps on it.

Blankets can release a lot of dust particles and fibres while we sleep posing us a risk of cold and cough allergies. Those should have covers that do not cause release of particles in air thus prevent allergy.

Use pollution mask

One should use a pollution mask and helmet while riding a bike and should wear the type of clothing that protects from cold air. Proper riding gear helps to prevent allergy.

 One who is allergic to soil particles can use a mask while playing outdoor games.

Do not swim in very cold water

 Swimming is one of the best exercises to maintain health but one should avoid swimming in cold waters.

Avoid contact with grass

If you are allergic to grass causing contact dermatitis you should play with full clothing so that your skin does not come in contact with grass and you are safe from the allergy. 

Have a balanced diet

Have a balanced diet daily. Food faddism can lead to malnutrition which can cause obesity or under-nutrition and also micronutrients and vitamins deficiency. Many vitamins if provided doses help to reduce allergic reactivity and allergies. Vit C and zinc helps to decrease respiratory symptoms of allergies. Remember that we should include the natural sources of foods containing Vit C and zinc in our diet. Vit D helps in a variety of skin allergy conditions. Vit A is good to boost immunity and maintaining overall growth.

Physical exercise

Do Daily physical exercise as a routine. It is as important as you eat and sleep daily. Everyone should exercise within their own capacity as needed and suitable for the age. Exercise helps to increase the physical and mental capacity. It helps us to maintain overall balance in health. Exercise daily at least for half an hour is good for maintaining long term health. It should be preferably outdoor activity like jogging, running, swimming, vigorous walking.

Breathing exercise

Daily breathing exercises. Till a few years back there was no evidence that breathing exercises help to decrease the allergies but now there is certain evidence that these exercises do help in reducing episodes and severity of allergic episodes to a significant proportion through yet unknown mechanisms.

If you are allergic to some medicine you should tell your consultant beforehand as you need to avoid those medicines.

Avoid animal milk

Those who have bovine milk allergies should avoid it. 

Do not give animal milk till 1 year of age. Animal milk in the first year of life causes various allergies in future.

Consume boiled egg

People who are allergic to egg proteins should take a vaccine where anaphylaxis care is available. Or they can get it after they undergo desensitization therapy.

If all these measures fail you need to get treated with medicines with the help of your doctor. Treatments can be curative for current episodes and long term treatment for the prevention of recurrence of episodes. 

Certain therapies like desensitization therapy are available to reduce the allergic reactivity in particular individuals to a particular allergic agent. Give those therapies to individuals with know allergic agents and allergy is so severe that it may be life threatening if occurs in future.



<span class="has-inline-color has-luminous-vivid-orange-color">Dr Yatin Bhole MBBS DCh DNB</span>
Dr Yatin Bhole MBBS DCh DNB

This article was written by Dr Yatin Bhole who is practicing Pediatrician at Bhole Children Clinic, Ravet. This post is for general information and before applying it on yourself, you should meet your doctor or meet us in person.



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