Atopic dermatitis is a common skin condition whose main symptom is intense itching. In dermatology, the term “dermatitis” is synonymous with “eczema.” Therefore, when we refer to atopic dermatitis or atopic eczema, we are talking about the same condition. In our country, the prevalence of this disease is around 10%, and the incidence is on the rise.
The exact pathogenesis has not been clearly defined; however, it appears to result from an interaction between genetic and environmental factors.
More specifically, the infant is born with an allergic predisposition, and then environmental influences (such as food allergens, airborne allergens, etc.) lead to the manifestation of dermatitis. Typically, one or both of the child’s parents have one or more of the following conditions: atopic dermatitis, bronchial asthma, allergic rhinitis, or allergic conjunctivitis.
Depending on the patient’s age, three types are distinguished:
Infantile atopic dermatitis
It begins around 3 months of age and presents with a characteristic rash on the cheeks, accompanied by intense itching. Skin lesions may also appear on the body.Childhood atopic dermatitis
Adult atopic dermatitis
It includes ages 4–5 years up to adolescence. Skin lesions are located on the flexural surfaces of the elbows and knees, the sides of the neck, and the eyelids. Dryness is observed over the entire surface of the skin.
Its main features are dry skin, the presence of inflammation, and lichenification of the flexural areas of the upper and/or lower limbs. Inflammation is often observed around the eyes or in the neck area. A very commonly affected area is the hands, as they are usually exposed to irritants during professional and domestic activities.
Atopic dermatitis is a chronic condition characterized by periods of remission and flare-ups. However, over time and with proper medical treatment prescribed by a dermatologist, improvement is commonly observed. Studies have shown that 50% of cases improve during preschool age. An even higher percentage (75%–80%) typically shows improvement or even complete remission by preadolescence. Additionally, 30%–50% of individuals, depending on the severity of their atopic dermatitis, may develop allergic bronchial asthma or allergic rhinitis later in life. Finally, in 10%–20% of cases, the disease persists and continues throughout the patient's life.
Atopic skin is often colonized by Staphylococcus aureus. In addition, the disrupted skin barrier allows easier entry of allergens, microbes, and irritants. If superinfection occurs, it leads to flare-ups and persistence of inflammation in the lesions of atopic dermatitis. Furthermore, individuals with atopic dermatitis tend to be more susceptible to viral skin infections, fungal infections, and parasitic infestations.
The choice of treatment is determined by the patient's age and clinical presentation. During the acute phase, corticosteroids (topical or oral) are administered for a specific period to ensure disease control. Calcineurin inhibitors are medications with an action similar to corticosteroids. Antibiotics, both topical and oral, are used in cases of lesion superinfection.
Systemic treatments for atopic dermatitis include medications such as montelukast, cyclosporine A, and mycophenolate mofetil. Oral antihistamines are prescribed to control itching. Phototherapy is considered a second-line treatment for children over the age of 10 and adults. Finally, it is worth noting that for severe atopic dermatitis, newer therapies such as immunotherapy are also available, showing very satisfactory results.
- The patient’s skin should be kept well moisturized.
There are specific products that your dermatologist can recommend for this purpose.
Nails should be kept short and clean.
Hot water should be avoided during bathing, as it worsens dermatitis.After bathing, the body should be dried with gentle patting motions.
Clothing should preferably be cotton and not wool or synthetic fabrics.
The patient’s room should be free of carpets or rugs and cleaned with a vacuum cleaner.
Emotional calm should be ensured, as psychological stress can aggravate the condition.