Atopic dermatitis

Atopic dermatitis is a chronic, non-contagious skin disease that presents with characteristic inflamed skin lesions.

This disease can be due to multiple causes, and can lead to a series of symptoms, which can be more or less annoying depending on the case. In the most severe ones, extensive and inadequately treated dermatitis could negatively affect the quality of life.

For these reasons, it is important to know how to recognize when you are faced with atopic dermatitis, know how to manage the different symptoms and prevent recurrence in case of recurrence.

What is it

Atopic dermatitis (also called atopic eczema) is a chronic inflammatory skin disease, with an immune basis, characterized by the appearance of inflammation and characteristic erythematous skin lesions. The reddened patches that appear on the skin can create significant physical and aesthetic discomfort, but it is good to know that they are absolutely not contagious.

The disease has an oscillating and relapsing course, characterized by moments of exacerbation (acute phase), during which skin symptoms are present, interspersed with periods of remission, in which the epidermis is completely intact and homogeneous, indistinguishable from that of a person who does not suffer from atopic dermatitis.

In general, those affected by this form of dermatitis have, more generally, a condition of atopy and are also affected by other allergic diseases, such as asthma, allergic rhinitis, urticaria and food allergies, or will tend to develop them over the years.

Atopic dermatitis is a widespread disorder in the population of all areas of the world, with a higher prevalence and an ever-increasing incidence in developed countries. Usually, being linked to genetic factors, it appears in early childhood and mainly affects children under 10-12 years.

However, the disease can arise at any age and, for some years, it has been increasingly found even in adults without a diagnosis of atopic dermatitis in childhood. It is therefore not unusual to find cases of this pathology even in adolescents, when the body is subject to rapid and irregular development, as well as being characterized by sudden changes in hormonal balance. More frequently, however, it is possible to find the first symptoms already in pediatric age, which, however, see an improvement with the progress of puberty.

In most cases, atopic dermatitis tends to undergo spontaneous healing or a more or less significant attenuation of symptoms with puberty and transition to adulthood. Sometimes, however, the improvement observed during adolescence (even reaching a prolonged complete remission) is only transient and can be followed by a reappearance of eczematous manifestations in early adulthood.

The causes

The causes of atopic dermatitis have not yet been fully clarified, but it is believed that at the origin of the disease there are several concomitant factors of various kinds (multifactorial etiology).

Among these must be considered the genetic predisposition, the psychosomatic state and environmental factors that act unfavorably on the balance of the epidermis, promoting an abnormal local inflammatory reaction.

To these, as already mentioned above, is added the natural predisposition to the development of allergies and disorders of the immune system. The latter, not surprisingly, is involved in multiple allergic reactions, both food and respiratory, such as, for example, spring allergic rhinitis.

Atopic dermatitis, having an immune basis, affects more severely, and is more common, in subjects who have pathologies of the body’s defense system, and a tendency to develop reactions to allergens.

In general, any external agent that can alter or weaken the skin barrier, directly irritate the epidermis or facilitate the penetration of allergens into the deeper layers can induce or worsen the symptoms of atopic dermatitis.

The main triggers include:

• dry skin
• hot and/or prolonged baths
• stress
• perspiration
• rapid changes in ambient temperature
• aggressive/inadequate soaps or detergents
• woolen or irritating garments
• dust or sand
• cigarette smoke
• high pollution
• certain foods.

Symptoms

The main symptoms of atopic dermatitis consist in the appearance of:

• areas of reddened and inflamed skin in characteristic points (erythema)
• discomfort and burning
• intense itching
• sensitive, dehydrated and sebum-free skin (xerosis)
• peeling and flakes on skin lesions
• in the most severe forms, vesicles, cuts and crusts in the inflamed areas.

The itchy sensation can be very marked and cause you to continuously rub the eczematous areas in search of relief. This stimulus must be absolutely inhibited because, in addition to not producing benefits, scratching worsens inflammation, damages the skin (exposing it to the risk of infections) and causes lichenification (ie a thickening of the epidermis, which peels and takes on a grayish color).

Not only that: constantly scratching the inflamed areas could lead to injury and force the skin to heal. The scars may subsequently struggle to disappear, and thus create even greater aesthetic discomfort, increasing the severity of the situation. Also for this reason, it is of fundamental importance to avoid harmful behavior.

The appearance and localization of skin reactions change depending on the age of the person affected by atopic dermatitis and the activity of the disease.

In newborns, the earliest manifestation is “cradle cap“, corresponding to a transient eczema localized on the scalp and characterized by the presence of yellowish scales and itching. Subsequently, in early childhood, reddened and moist skin lesions appear, especially at the level of the face (cheeks, eyes, mouth and forehead) and on the ears, but other body sites may also be involved in a variable way.

In later stages of childhood, eczema always takes the form of reddened patches, but more dehydrated and flaky; The body distribution of lesions also changes, concentrating mainly at the level of the folds of the elbows and knees, as well as in correspondence of hands and feet.

In adulthood, however, the manifestations of atopic dermatitis are mainly localized on the face, neck, shoulders and trunk, in the form of patches covered with vesicles and crusts (nummular eczema), chronic intense itching (chronic prurigo) or as areas of inflamed, scaly and itchy skin around the eyes, nose and mouth (periorifictial dermatitis).

One of the main characteristics of the symptoms of atopic dermatitis is the similarity with psoriasis: a very similar skin disease, but with some differences.

Despite being different diseases, they can easily be confused. One of the main ways to distinguish them is the age of onset: while in atopic dermatitis it is frequent to see the first episodes during childhood, psoriasis occurs more frequently with adulthood, once the first quarter of life has passed.

However, only a careful and controlled dermatological examination can identify the correct disease, applying the necessary distinctions and setting the most suitable therapy.

Diagnosis

The diagnosis of atopic dermatitis is essentially clinical, i.e. based on the observation of the signs that appear on the epidermis (type, size, shape and location of skin lesions) and on the evaluation of the associated symptoms (intense itching, burning, etc.), taking into account the age and personal characteristics of the patient.

In addition, the doctor will have to examine the familiarity for atopic dermatitis, asthma and allergic disorders of various types (food, mites, molds, seasonal pollen, etc.), since atopy conditions, having a genetic basis, tend to affect more members of the same family (consanguineous) and to affect more often children with one or both atopic parents.

In general, it is not recommended to perform laboratory or instrumental tests to support the diagnosis of atopic dermatitis, since to date there are no specific markers of disease. In some cases, evaluation of total blood immunoglobulin E (IgE) levels may be required: a parameter, as a rule, increased in the presence of allergic activation and, often, also in the presence of atopy.

A medical consultation is the first recommended approach to know immediately if it is necessary to perform specific tests. Specialists will be able to identify the need and analyze the tissues affected by the disease, so as to take the most appropriate actions to improve the patient’s life.

Investigations of various types may, however, be prescribed to exclude the presence of other disorders characterized by manifestations and symptoms similar to those of atopic dermatitis, such as seborrheic dermatitis, contact dermatitis (allergic or irritative), diseases of the immune system, severe nutritional deficiencies or some tumors (in particular, cutaneous lymphoma).

Aftermath

Children suffering from atopic dermatitis have an increased chance of developing allergic disorders, especially asthma, allergic rhinitis, urticaria and (much more rarely) anaphylactic reactions, over the years. Similarly, those who suffer mainly from asthma and/or allergic rhinitis in childhood/adolescence may develop atopic dermatitis as an adult.

The presence of atopic dermatitis also makes the skin particularly prone to becoming infected, especially in areas where excoriated skin lesions are present. In particular, infections with bacteria (mainly, Staphylococcus aureus) are quite frequent, but also viral infections with Herpes simplex and molluscum contagiosum.

The formation of infections could become serious in cases where the child affected by atopic dermatitis does not have a fully efficient or non-functioning immune system, as in the case of immunosuppressed subjects. In specific cases, proper training is essential to prevent the worst consequences and prevent complications from arising.

A further problem is represented by the propensity of subjects with atopy to also develop irritative and inflammatory dermatitis of the hands, as well as allergic contact dermatitis (DAC), which can cause serious discomfort and limitations in daily and professional life.

Especially during adolescence and adulthood, the symptoms and aesthetic damage related to skin lesions can also cause psychological problems, with negative repercussions on self-esteem and social relationships; In children, however, intense itching can cause sleep disorders that greatly reduce the well-being and quality of life of the whole family.

A familial predisposition to atopic dermatitis can be an important alarm bell to prevent the most acute phases of the disease, in the children of subjects who have already been affected by the disease in the past, and can be useful to avoid the most annoying psychological and physical consequences.

Therapies

To date, there is no definitive cure for atopic dermatitis: there are only preventive measures that aim to reduce the frequency of exacerbations and therapies to control the disease, alleviating its symptoms.

In all cases, to get precise and reliable advice and indications on which topical or systemic treatments to use, how and for how long, it is necessary to contact dermatologists expert in atopic dermatitis. Only in this way, it will be possible to obtain the maximum benefits from the treatments and minimize the risk of worsening and complications.

A fundamental aspect of the management of the disease throughout its course (i.e. both during acute phases and during periods of remission) concerns the deep hydration and daily nourishment of the epidermis with quality moisturizers and emollients. The regular use of products of this type, after each bath or shower, allows to protect the skin barrier, preventing dehydration and sensitization and thus reducing the risk of triggering an acute phase.

The presence of skin lesions requires therapy with topical anti-inflammatory or immunomodulatory drugs, generally based on corticosteroids in combination with specific moisturizers, developed for people with atopy. Moisturizing and emollient formulations containing lipids similar to those naturally present in the epidermis (such as glycerin and ceramides) and humectant and regenerating agents (such as panthenol) allow to strengthen the layer of cells of the stratum corneum and therefore the skin barrier, facilitating the remission of the symptoms of atopic dermatitis.

In addition, the use of a moisturizer on a daily basis can be useful not only for the prevention of atopic dermatitis, but also for the well-being of the skin itself, and to prevent the onset of wrinkles and signs of aging. Added to this is attention during hygiene: showering and bathing, for example, should never be done with water at an excessively high temperature, because it could weaken the skin’s natural defenses.

When the disease is very severe, spread over large body areas or localized in critical areas and / or with very delicate and sensitive skin, it may be preferable to use treatments with corticosteroids or systemic immunomodulators, administered by mouth or injections, for variable periods of time. In case of widespread intense itching, especially if atopic dermatitis is associated with allergic disorders, antihistamine drugs may also be useful. Scrupulously following the instructions of your doctor.

Sometimes, in children over 12 years and adults, the dermatologist can also propose phototherapy, based on cycles of sessions of controlled exposure to UvA or UvB rays of defined frequency and intensity, with or without the preliminary application of photosensitizing compounds. This approach allows to reduce the inflammatory reaction of the atopic skin, attenuating skin lesions.

Recently, specific probiotic-based food supplements have been offered for sale in pharmacies that aim to assist traditional long-term treatments, reducing relapses and improving symptoms. To these it is important to associate and follow a balanced diet and already rich in all the essential nutrients that our body needs for its well-being.