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Atopic dermatitis (AD) is a condition that most often occurs as a result of contact with allergenic food and / or inhalation allergens. Bacterial and viral antigens released from chronic intracorporeal foci also play an important role. Atopic dermatitis often coexists with bronchial asthma and a predisposition to dry and keratinized skin.
What is atopic dermatitis?
Atopic dermatitis is an allergic skin disease that most often occurs as a result of contact with allergic skin and inhalation allergens. The formation of atopic dermatitis involves many different cells and the active substances they produce, the so-called cytokines.
Characteristic symptoms of atopic dermatitis there are repeated cycles of symptoms together with their remission and periodic worsening (irritation turning into wounds). Another troublesome symptom of the disease is unbearable itching of the skin, which increases depending on the severity of the disease. The diagnosis of atopic dermatitis is not easy because many other allergic ailments are associated with itching and irritation of the skin.
Atopic dermatitis is often accompanied by bronchial asthma and a more or less marked tendency to hyperkeratosis and dry skin.
Frequency of appearance
AD is a common disease in children. In Poland, it occurs in 4,7% of children aged 3-16 and in 1,6% of adults. The onset of changes up to 6 months of age is observed in 49%, up to 3 years of age in 75%, and up to 5 years of age in 82,9% of all AD patients. The number of patients with a positive family history is about 60-70%. After adolescence, 10-15% of symptoms still persist.
The causes of atopic dermatitis
Among the causes of atopic dermatitis, there are three main etiological factors of this disease:
1. Defective immune system – an allergic reaction occurs when the immune system gives a sign that substances present on the skin or in the body threaten the allergy sufferer. Inflammation then develops and tries to remove the harmful factor. In allergy sufferers, the balance between individual components of the immune system is disturbed.
2. Genes predisposing to allergic reactions – people who suffer from atopic dermatitis very often have people in their family who suffer from various types of allergies, e.g. asthma or hay fever, so certain predispositions are inherited. According to the latest research, people with atopic dermatitis are born with skin that has slightly different properties than others. This applies primarily to the insufficiently protected epidermis, the cause of which is filagryna. Filaggrin is a protein responsible for the proper functioning of the protective barrier of the epidermis in healthy people. On the other hand, in atopic people there is a gene mutation that is responsible for the coding of filaggrin in the body.
3. Allergens – are factors that irritate the human immune system, we distinguish among them:
- soybeans
- milk,
- eggs,
- short,
- peanuts,
- dry air,
- cold air
- grain products,
- scratching,
- polluted air,
- chemicals,
- smoke
- cosmetics with a strong effect,
- stress,
- washing too often, which deprives the skin of its protective layer,
- sudden changes in temperature.
Symptoms of atopic dermatitis
The skin changes accompanying atopic dermatitis may begin as early as the first year of life (often around the first month). The first lesions usually appear on the cheeks and scalp. These are:
- erythema,
- lumps
- bubbles
- oozing erosions and scabs.
Over time, new lesions begin to seed on the torso and flexion surfaces of the limbs. As a result of severe itching, the baby is usually very irritable and unable to sleep at night. In addition, a secondary bacterial contamination is often superimposed on scratches.
If a child is breastfed during AD, the mother’s nutrition should be analyzed and, if necessary, strong allergens should be eliminated from the diet (they may pass into breast milk).
On the other hand, if the child is fed artificially, after consulting a pediatrician and a dietitian, change the type of milk used for admixture or, as a last resort, replace it with dairy-free soy preparations. AT children suffering from AD fruit juices and eggs are introduced into the diet much later than in healthy children.
Around the age of 2, skin changes begin to recede or change their location ((wrists, elbow and knee bends, neck, backs of hands and feet) and character. , scaly.
In mature patients, the hair on the head becomes thinner, as well as the sides of the eyebrows. This is due to the constant scratching associated with unbearable itching. In addition, the lymph nodes may also become larger.
The acute phase of atopic dermatitis It is characterized by skin eruptions in the form of erythematous foci, which are separated from the skin and have small lumps, vesicles and erosions on their surface. In turn, in the sub-acute phase of AD, apart from erythematous foci, the so-called quirks caused by scratching and thus damaging the epidermis (disappear completely after healing).
Chronic AD causes impetigo.
Diagnosis of atopic dermatitis
In the diagnosis of atopic dermatitis, the observation of the symptoms that occur in the patient plays an important role. In turn, the diagnosis is confirmed on the basis of skin tests, which indicate an allergy to specific allergens. In order to be able to talk about atopic dermatitis in a given patient, he or she should have at least 3 main clinical features and at least 3 minor features described according to the Hanifin and Rajka classification.
Skin tests in the diagnosis of atopic dermatitis their main purpose is to detect the allergen to which the patient is allergic. However, it should be remembered that a positive skin test with an inhalation and food allergen does not clearly indicate that this component is responsible for the symptoms of the disease. In everyday life, we can observe that eating certain foods causes skin symptoms – then skin testing is a good method to confirm suspicions.
If there are any diagnostic doubts, it is important to test for other ailments, because atopic dermatitis is sometimes confused, for example with contact eczema, scabies or symptomatic scabies. Total IgE testing is helpful in differentiating the disease, although the correct concentration of these antibodies does not rule out AD in XNUMX%.
It should also be remembered that the level of IgE in the blood does not correlate with the symptoms of the disease or the amount of allergens to which the patient is allergic. The activity and exacerbation of the disease is only indicated by the deterioration of the skin condition of patients with AD.
Atopic dermatitis – management
A child suffering from atopic dermatitis should be under the close supervision of a dermatologist or allergist from early childhood. The care tips they give are very important. Here are some practical tips for managing atopic dermatitis.
- Do not stay in smoky rooms, because tobacco smoke has a bad effect on the patient’s skin.
- Patients should also avoid air-conditioned rooms.
- It is worth avoiding swimming pools with chlorinated water.
- Instead of taking a bath, it is better to take a shower (prolonged exposure to water dries out the skin).
- It is important to avoid dusty and dirty rooms.
- Wool irritates the skin, so avoid wearing woolen clothes.
- Instead of using regular bath lotions and soaps, use synthetic cosmetics that do not contain artificial substances.
- Before you take a shower or bath, rub a protective substance on your body.
- After bathing, remember to lubricate the skin, e.g. with olive oil or greasy creams.
- Wash clothes and bedding in special detergents and liquids intended directly for allergy sufferers.
- Dogs, parrots or cats should not be bred in a home with children with AD.
- Keep the house clean (remove accumulated dust).
In the case of AD symptoms or psoriasis appearing on the hair and scalp, the Atopos treatment can be used, which reduces the unpleasant feeling of itching and cares for dry skin.
- Seborrheic dermatitis – causes, treatment
Atopic dermatitis – what is the prognosis?
The prognosis for atopic dermatitis depends on the severity of the disease. The earlier the onset of skin lesions, the worse the prognosis. After puberty, the disease persists in about 10-15% of patients. Some patients suffer from other allergic diseases, especially bronchial asthma and allergic rhinitis.