DR. J. OHAYON - ALLERGY & IMMUNOLOGY CLINIC

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What is atopic dermatitis?

Atopic dermatitis is a chronic skin disease that involves inflamed, red, itchy skin with possible fluid oozing and weeping from the skin caused by abnormalities in the skin barrier and immune system. Despite common belief, atopic dermatitis is not contagious. Atopic dermatitis is a specific form of eczema which refers to a group of diseases that cause inflammation of the skin.


The prevalence of atopic dermatitis is on the rise, currently affecting 10 to 20% of children and 1 to 3% of adults around the world. 90% of individuals with atopic dermatitis develop it before the age of 5, it rarely develops in adulthood. An estimated 60% of children outgrow atopic dermatitis and have clear skin by the age of 10. If atopic dermatitis persists into adulthood, the symptoms are generally much milder.


Symptoms of Atopic Dermatitis:


Infants:

- Dry, scaly, itchy skin generally on the scalp and face, usually cheeks.

- Itching that may come and go.

- Rubbing against bedding and carpet to relieve itch.

- Common skin infections due to rubbing and itching.


Children and Teenagers:


- Rash generally in creases of elbows and knees, may also be on the neck, wrists, or ankles.

- Itchy and scaly patches where the rash is.

- Possible thickening and discolouration of skin where atopic dermatitis is.


Adults:

- Very dry, itchy, and scaly skin on creases of elbows, knees, neck, and face.  

- Skin infections.

- Possible thickening and discolouration of skin.

Currently there is no cure for atopic dermatitis. However, there are many treatment options to prevent the worsening of atopic dermatitis, relieve pain and itch, and prevent infections.


Bathing:

- Bathe in warm, not hot, water and limit the use of cleanser and baths to 5 to 10 mins.

- Cleansers should be mild and fragrance-free.

- No bubble baths.

- Pat skin dry, do not rub.


No scratching:

- Scratching further damages the skin barrier.

- For children, keeping finger nails short  and cotton gloves at night can help limit scratching.


Washing clothes:

- Limit use of detergent, scented fabric softeners, or dryer sheets.

- Limit use of detergent and use enough water to adequately rinse clothes.

- Buy clothes without tags to limit irritation from rubbing.

- Wash new clothes before washing to remove dyes and fabric softeners which can irritate skin.


Bleach bath:

- For frequent skin infections, bleach baths twice a week may be helpful.

- Use regular strength 6% bleach and add to bath using a measuring cup or spoon while the bath is running to thoroughly mix. For a full bathtub, use half a cup of bleach. For half a bath tub use a quarter cup. For a baby or toddler bath use one teaspoon per gallon of water.

- Do not add bleach directly to child’s skin.

- Wait until bath is fully drawn and bleach is thoroughly mixed before your child enters the tub.

-Consult with your doctor before initiating bleach baths.


Moisturizer:

- Apply moisturizer at least twice a day prevent dry skin and cracking, ideally with a thick cream or ointment which have higher oil content. Vaseline is suitable for most children.


Topical corticosteroids:

- Used for mild atopic dermatitis on eczematous lesions to calm itch and inflammation, allowing skin to heal.

- Use with caution. Avoid face and minimize duration of use with higher doses.


Topical calcineurin inhibitors:

- Anti-inflammatory mediators that inhibit activation of immune cells involved in atopic dermatitis.


Wet wrap therapy:

- For difficult to control atopic dermatitis, wet wrap therapy may be helpful to facilitate skin barrier recovery, increase efficacy of corticosteroids, and protect skin from scratching. Refer to our instructional videos for further information on wet wrap therapy.

Treatment and tips

Cause, triggers, and risk factors

Cause:

The cause of atopic dermatitis is unclear. However,there appears to be an interplay between genetics, skin barrier, immune system, and environmental factors.


In a healthy individual, the skin barrier acts as a shield protecting our body from external stressors and maintaining moisturization. Individuals with atopic dermatitis often have a defective skin barrier resulting in dry skin and split skin which pathogens and allergens can enter through. These pathogens or allergens activates the immune system, resulting in local inflammation which causes the patches of eczema. Inflammation then results in itching and scratching which causes further damage to the skin barrier, thus initiating a viscous cycle.


Triggers:








Risk factors:

Genetics: Family members with atopic dermatitis, asthma, or hay fever.

Environment: Living in a developed country or in cold climates.

Gender: Females have a slightly higher risk.

Social class: Higher social class is more at risk.

Mother’s age during birth: Increase in mother’s age at time of birth increases the child’s risk.

- Irritants/soaps that increase skin dryness and water loss.

- Allergies.

- Sweat.

- Stress.

- Cold temperatures leading to dry skin.

- Infection.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122281/

https://nationaleczema.org/eczema/types-of-eczema/

https://www.aad.org/public/diseases/eczema/atopic-dermatitis

https://www.ncbi.nlm.nih.gov/pubmed/25017522