Atopic dermatitis

Atopic dermatitis

Atopic dermatitis (AD) is a chronic inflammation of the skin which is characterised by an itchy scaly lesion appearing on typical location and general dryness of the skin. It is often accompanied by other illnesses, such as bronchial asthma or allergic rhinitis, and together they form the so-called Atopy, Atopic terrain, or Atopic syndrome. In the latest years the number of cases of AD have increased. It typically affects between 15% and 30% of children, and in about 45% of all cases the symptoms appear in the first 6 months of the child’s life. Potential reasons for the illness are genetic predisposition (there are other members of the family suffering from AD, allergic rhinitis, or asthma) and environmental factors (cosmetic products used, pollution, food, infections). Main characteristic of the atopic skin is the considerable weakness of its (skin) barrier. Mutations of the human gene encoding filaggrin (type of protein) have been found. Filaggrin helps the building of the cell structure of stratum corneum (the outermost layer) of the epidermis and is related to sustaining the good hydration of the skin. If the protein is defective or missing, this will lead to breakage of the skin barrier, dryness and itching. Other components, such as the ceramides, are also decreased in number. All this makes the skin more permeable and prone to Staphylococcus aureus infections, worsening the inflammation. Clinical cases very depending on the age. In children between 0 and 3 years of age the lesion appears first on the cheeks and scalp, and the skin on the torso and limbs becomes dry. Clusters of small bumps may appear. Red, scaly and dry flakes form on the lesions. Itching starts a few weeks after the lesion and the parent will notice scratching marks. More prominent crusty patches on the hairy parts of the head in babies may be a symptom of AD. In children more than 3 years old the skin remains dry and sometimes rough and cracking. Itching is intense and the lesion appears in the folds of the elbows, knees, ankles and wrists.

There are many factors that worsen the condition. Some of them are cold weather, strong wind, viral and bacterial infections, wool clothes. As for whether or not the child should stick to a strict diet, there are contradicting opinions. Some specialists say that dairy products, chocolate, eggs, etc. should be removed from the child’s menu. Others say only foods that the child is allergic to and such that seem to worsen the AD symptoms should be avoided. Wearing clothes made of cotton and layered with micronised silver, which lowers the risk of Staphylococcus aureus colonisation, is recommended.

Of crucial importance is parents to learn how to adequately care for their child’s skin and how to keep it moisturised. Showering should be done with a cooler water (about 32⁰ С) and a specialised bath/shower oil. After the bath the parent should dry the baby’s skin well and apply an emollient containing lipids, such as ceramides, omega-6 fatty acids, cholesterol. It is best to apply the emollient twice a day. In children suffering from AD, how often they take a bath also matters. Daily bathing is not recommended because it is believed that it washes away the protective layer of the skin (bathing every other day would be better). If there are other family members who suffer from AD, start using emollient right after the baby is born as a precaution.

Medical treatment (with medicines) can be local (on affected skin patches) or systemic (received orally). Typically, corticosteroids and calcineurin inhibitors are used. In mild cases local treatment is administered. In acute cases locally applied medicine is used for a specific period of time and after it the little patient sticks to a follow-up emollient skin care. Lately, the so-called proactive treatment has been widely administered. The method involves the application of local corticosteroids (2 – 3 times a week) during remission periods (when there is no lesion) as an addition to the emollient skin care therapy. In more severe cases medicines are prescribed in small to medium doses. If there is no result, immunomodulators can be included, such as Methotrexate, Azathioprine , etc. Lately, phototherapy has also been used. There are patients reported to have “outgrown” the condition around the age of 3 – 5 years

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