Atopic Dermatitis - Eczema

It is often combined with other atopic manifestations such as allergic rhinitis, asthma, allergic conjunctivitis and intolerance to certain foods.

The etiology of the disease is immunological. Substances that are common in the environment are recognized by the body as allergens and trigger the production of inflammatory molecules, responsible for the manifestation of the disease.

The clinical manifestation varies according to age, with itching and dry skin being the main feature. In infancy, it demonstrates as eczema on the cheeks, where in mild cases, redness, dryness and peeling appear. In more severe forms, blisters and crusts may form and the entire face may be affected except for the paranasal sinuses and around the mouth.

In childhood, atopic dermatitis usually develops on the flexural surfaces of the extremities (inner elbow and behind the knees), the neck, the wrists and the eyelids. The skin appears dry, irritated, while thickening, peeling and micropigmentation is created due to intense and in severe cases excruciating itching. In adults, in the few cases where the disease persists, it develops in the same areas as in children, while it is often accompanied by dermatitis of the hands, feet, and perianal region.

People with atopic dermatitis suffer more often from food allergies and urticaria, while they are more sensitive to staphylococcal and viral infections, while RAST tests for mites, house dust, pollen, pet dander and mold can be positive.

From the laboratory findings, immunoglobulin E (Ig E) is usually increased, but the clinical picture can be from very mild to very severe.

Therapeutically, the avoidance of triggering factors is imperative. Triggering factors may be dust, animal hair, foods that cause intolerance, antiseptics and soaps that cause dryness, woolen clothes that act as irritants. Also, it is particularly important to use emollients, moisturizing agents and bath oils that protect the skin from dryness and provide relief from itching.

The emollient care is of great importance. It keeps the skin’s barrier intact against microbes which can trigger an outbreak of the disease. It is very important to keep the balance of the microbiome of the skin surface.

In the acute phase, antihistamines and oral antibiotics help a lot, while in mild forms, topical corticoids and antibiotic ointments are recommended.

Steroid (corticosteroids) preparations should be used once a day and only in the acute phase (which may however last a few days to weeks). After the acute phase, the use of topical immunomodulators (tacrolimus and pimecrolimus) is indicated for children older than 2 years. These are not cortisone preparations but may be followed by a burning sensation after the first applications. It is emphasized again that the daily emollient skin care reduces flare-ups and is the mainstay for the atopic dermatitis care.

In persistent forms, mainly in adults, photochemotherapy (PUVA) has been therapeutically used, and more rarely, systemic treatment with cyclosporine or interferon.

There are new drugs in the market who have very promising results in the management of atopic dermatitis in the last 5 years JAK inhibitors.

In conclusion, atopic dermatitis is a disease, the treatment of which requires patience and discipline in the skin care routine and, of course, presupposes the close cooperation of the parent with the dermatologist.