Atopic dermatitis is a chronic, undulating skin disease characterised by inflammation, severe dryness and intense itching. Children are the most common sufferers of atopic dermatitis, but sometimes adults are affected too. Heredity has a strong influence on the development of the disease. It has been shown that if one parent has atopic dermatitis, the risk of the child developing it increases by up to 50%. Often, this skin disorder is associated with other allergic diseases such as allergic rhinitis and bronchial asthma. If left untreated or inadequately treated, bacterial or viral infections can contribute, further complicating the course of the disease and quality of life.
What can cause an exacerbation of atopic dermatitis?
- Food allergens such as eggs, cow’s milk and its products, fish, nuts, soya, wheat, seafood, citrus fruits etc.
- Airborne (inhaled) allergens, e.g. house dust mites, pets, pollen, moulds, pillow fluff, etc.
- Various chemicals, household chemical products such as laundry detergents.
- Environmental factors such as woollen or synthetic clothing, hard tap water, heat, cold, humidity, sweating
- Use of certain medicines
- Stress, nervous tension
- Improper care of dry skin
- Various skin infections
Main symptoms of atopic dermatitis
- The disease flares up periodically, with an undulating course
- Itchy skin rashes. Sometimes the itching is so intense that it interferes with daily activities and sleep.
- The rashes are symmetrically arranged
- The location of the rashes depends on the age of the patient:
- In young children (infants, toddlers up to 4 years of age), the rash appears on the face and neck, then spreads to the trunk and affects the extensor surfaces of the arms and legs. In children, a ‘wet’ form of the disease is observed – redness, swelling, blisters, urination. Scratch marks, scabs are observed. In severe disease, lymph nodes may enlarge. Children become irritable, restless, sleep poorly.
- In older children and adults, the sides of the neck, the nape of the neck, the palms of the hands, the flexor surfaces of the arms and legs are most commonly affected. The ‘dry’ form of atopic dermatitis is characterised by dryness, nodules, scaling, scraping and slight swelling. The skin thickens, becomes more pigmented and rough. The skin on the soles of the feet and palms of the hands may thicken and the skin of the whole body may become very dry.
Diagnosis of atopic dermatitis
Atopic dermatitis is diagnosed on the basis of the characteristic signs of the disease. To facilitate diagnosis, certain protocols have been developed, such as the American Dermatological Association’s diagnostic protocol for atopic dermatitis, which includes:
- Signs of dermatitis
- Chronic and undulating course of the disease
- Characteristic rashes and lesion sites:
- Infants and young children: face, neck, extensor surfaces of extremities
- Older children and adults: flexor surfaces of extremities
- Early onset of disease
- Pre-existing allergic diseases, family history of allergic diseases
- Elevated immunoglobulin E (IgE) in blood test
- Dry skin
Additional tests are indicated in unclear cases and to clarify the origin of the disease and the factors provoking the disease:
- Complete blood count
- Serum blood tests to determine total IgE and specific IgE concentrations (elevated levels are indicative of an allergic origin of the disease)
- Allergic skin samples (skin prick, skin patch, etc.). These are carried out by an allergist-clinical immunologist.
- Skin biopsy when the diagnosis is not clear and the aim is to differentiate the disease from other similar skin conditions.
Classification of atopic dermatitis
Atopic dermatitis is classified as mild, moderate or severe according to its course.
Criteria for mild atopic dermatitis:
- The disease does not interfere with daily activities, sleep
- Dry skin
- Blurred rashes
- Exacerbations of the disease are of short duration and rarely recur
Moderate to severe atopic dermatitis:
- Deterioration of general condition, sleep disturbance, poor appetite, increased irritability, abdominal pain and other gastrointestinal problems
- Widespread rashes
- Extremely troublesome itching
- Very dry skin, quickly damaged by external factors
- Frequent, prolonged and difficult to manage exacerbations
Atopic dermatitis is distinguished from nappy dermatitis, contact dermatitis, seborrhoeic dermatitis, food-induced dermatitis, dry skin dermatitis, scaly dermatitis, drug-induced dermatitis etc. If you notice itchy skin rashes, it is advisable to consult a doctor who will determine the exact origin of the condition and prescribe the most appropriate treatment.
Treatment of atopic dermatitis
The treatment of atopic dermatitis is long-term, complex and individual. Basic principles:
- Avoiding allergens and other irritants that provoke the disease.
- Restoring and maintaining the barrier function of the skin.
- Treatment of skin inflammation.
- Treatment of complications (e.g. bacterial skin infections).
- Educating the patient and their family.
- Psychological support.
Education of the patient and his/her family includes not only adherence to the doctor’s recommendations, but also recognition and avoidance of allergens and other irritants. General recommendations for atopic dermatitis:
- Avoid coarse fabrics and woollen clothing during exacerbations. Instead, choose soft, natural fibre fabrics such as cotton.
- Avoid coarse, rough sponges and towels.
- Choose neutral hygiene and body care products and laundry detergents that are free of dyes, fragrances and alkalis.
- Ventilate well.
- Avoid chlorinated water.
- It is recommended to take a cool shower daily.
- Keeping a sick diary, daily records of food eaten, environmental features, medications taken and the skin’s reaction to all these factors is recommended. This will help to find out the provoking factors of the disease.
- Choose bedding that is free of feathers, down and synthetic fibres.
Maintaining the barrier function of the skin:
- The most important thing is frequent application of moisturising creams, at least 2 times a day (ideally 4-6 times a day). Creams and lotions are suitable for the acute period of the disease, when the skin is wet, while creams and ointments are suitable for the chronic period of the disease, when thickened skin is a problem.
- After bathing, apply moisturising creams within 3 minutes.
- When bathing, use special bath oils that provide a protective film on the skin.
- To avoid scrapes, keep nails short and wear cotton gloves at night.
Corticosteroids can be used to treat skin inflammation. Calcineurin inhibitors are suitable for sensitive areas such as body wrinkles. For itching, oral anti-allergic drugs. Oral corticosteroids are used only in particularly severe cases of atopic dermatitis. Phototherapy – treatment of skin diseases with ultraviolet rays – is also available for children over 12 years of age. For more information, see “PUVA therapy”.
In the event of a complication such as a bacterial infection, antibiotics are prescribed. Timely and appropriate treatment prevents complications.
Psychological counselling is also recommended for all patients, as atopic dermatitis worsens the quality of life of both the patient and his/her family due to sleep disturbances, emotional problems and feelings of inferiority.
How can I avoid exacerbations of atopic dermatitis?
- Keep a diary to help you recognise the provoking factors.
- Maintain regular contact with your doctor and follow all treatment recommendations. The best result is achieved when all the measures recommended by the doctor are applied.
- Adjust your environment – avoid too dry or too humid air, avoid sweating, avoid infections.
- Remove allergens in the environment (e.g. house dust mites, animal hair).
- Avoid psychological stress, overwork. It is recommended to find your most relaxing leisure activity, e.g. yoga, meditation.
The treatment of atopic dermatitis is a long process and requires close cooperation between the patient and his/her doctor. It is therefore not recommended to treat the disease yourself, but rather to consult a dermatologist who will assess your skin condition and prescribe the most appropriate treatment.