In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
This chronic skin disease is very rarely life-threatening, but it can make it simply unbearable, leading to depression and social withdrawal. Research shows that every fifth patient with the most severe form of AD manifests suicidal thoughts. In most cases, the disease begins in the first year of life and often never goes away. Recent reports are changing the way we look at its causes.
Mom, it itches !!!
Recent statistics show that the problem of atopic dermatitis (AD) affects about 20% of children, while the prevalence of the disease among adults is estimated at about 1%. The incidence of the disease has been increasing in recent years, especially in highly developed countries. Studies show that 60-85% of cases of the disease develop in the first year of life, and 95% in the first five years. In about 40% of patients, the symptoms of the disease disappear before adulthood, however, in a large percentage of AD, it accompanies patients throughout their lives.
The disease manifests itself differently depending on what age it begins. Its main symptom, however, is severe itching of the skin. Babies sleep uneasily, are irritable, rub their hands – trying to scratch – itchy spots. Older children directly report their ailments to their parents, and on their skin you can see places where the skin has been damaged due to intense scratching. The skin in AD is also very dry, flaky and rough. In addition, in the acute phase of the disease, a rash appears, usually taking the form of itchy papules and vesicles. The skin in this area is inflamed. In the youngest children, these changes are most often located on the cheeks – it is said about the so-called varnished cheeks, red, flaky, rough and shiny. Changes can also appear on the scalp and on the outer side of the joints of the arms and legs. In the most advanced cases, generalized skin involvement may occur, although the area covered with a diaper is often spared. In old age, inflammatory changes are most often located on the inner surfaces of the joints – in the bends of the elbows, knees, wrists or the front surfaces of the ankles. The inflammation that takes place over the years leads to thickening of the skin in these places, then the naked eye can see the “scales” that make up the epidermis. Sometimes itchy papules are mixed with purulent pustules, which indicates superinfection of the affected skin. The most common culprit then is staphylococcal strains. In adults, the changes often include the hands, face (including the eye area), the skin around the articular flexions is thickened and red, there are numerous scratch marks – the so-called quarrels. A huge problem that causes serious emotional problems – apart from persistent, nagging itching – are skin lesions located in the intimate areas.
The diagnosis of the disease is made on the basis of the characteristic image of skin lesions and typical accompanying symptoms such as itching, dry skin or recurrent skin infections. The disease progresses in the form of exacerbations and remissions, and varies in severity for each patient. The factors exacerbating the course of the disease include stress, exposure to various types of irritants (detergents, solvents, sweat), low air humidity, overheating, stress and – a phenomenon that is currently highly controversial – i.e. certain foods.
What about this allergy?
Although the mechanisms leading to the development of the disease are still not fully understood, in recent years a lot has changed in the way of looking at the potential causes of this disease. The medical world now seems to be divided into supporters of the hitherto existing allergy theory and those who blame the disease’s development in the wrong functioning of the outermost layer of the epidermis. For many years, AD was perceived as an allergic disease. Many patients showed elevated levels of IgE antibodies involved in allergic reactions in the blood serum. Skin lesions were to reflect a disease throughout the body, resulting from allergies to various types of food allergens (mainly cow’s milk proteins in children), inhalation or antigens of various types of microorganisms (staphylococci, fungi). However, putting an equal sign between the so-called protein diathesis, i.e. allergy to cow’s milk proteins, and atopic dermatitis is a simplification, if not a mistake.
In recent years, more and more is being said about the role of the epidermis in the development of the disease. Research has shown its key role in maintaining the proper protective function of the skin. The most important role is played by keratinocytes (producing, among others, a protein called filaggrin, which is the substance from which the so-called natural moisturizing factor is produced) building the constantly exfoliating horny layer of the epidermis, the proper functioning of which ensures adequate hydration of the skin and enables it to perform protective functions and barrier. As a result of the impaired function of keratinocytes, due to genetic mutations not fully known so far, there is excessive loss of water through the skin and its increased permeability to irritating and allergenic substances in the environment, which easily penetrate into the skin, initiating inflammatory processes and stimulating cells immune system, involved in allergic mechanisms. In conclusion, it is not sensitization that causes dermatitis, but a damaged, malfunctioning skin barrier that promotes sensitization.
Scientific research shows that atopic dermatitis coexists with other allergic diseases. About one third of patients have bronchial asthma and / or allergic rhinitis. It is also known that AD can coexist with various types of food allergies (cow’s milk protein, egg white, soy, nuts, etc.). This occurs in about one third of severe AD, but in only 1 to 3% of mild AD. Hence, in recent times, the need to confirm food allergy before introducing an elimination diet has been emphasized, which – as shown by the above data – may turn out to be effective only in 30% of the most severe cases of the disease (where it is necessary), and is associated with the risk of malnutrition in the youngest children.
Multidirectional treatment
Treatment of atopic dermatitis is a tedious process that requires enormous discipline and time, and, unfortunately, not always successful. Its task is to reduce itching, control skin lesions and prevent relapses. The basis of treatment is proper skin care. All patients are recommended to have proper skin hygiene and regular use of the so-called emollients – agents whose task is to restore proper skin hydration and create a protective lipid coat. The first-line drugs to combat inflammation are topical corticosteroids in the form of various types of ointments and creams. Due to numerous side effects and the need to select the preparation used depending on the area involved, this treatment should be carried out under the supervision of a specialist. In recent years, new topical medications (tacrolimus, pimecrolimus) have also appeared, devoid of the side effects of glucocorticosteroids and have proven themselves well in maintenance and relapse prevention treatments. In Poland, however, the price of these preparations, available only in small packages, which prevent their use on large parts of the skin, remains a barrier. There is also some controversy about the potential, still scientifically unproven, relationship of these drugs with the formation of skin cancers and lymphomas.
In the treatment of AD, it is also important to avoid and eliminate factors exacerbating the course of the disease (drying, excessive sweating, stress). In the light of recent reports, an elimination diet, excluding foods containing the most common allergens, is recommended only in cases of confirmed allergy – and not routinely. On the other hand, taking into account stress as a potentially exacerbating course of atopic dermatitis, professional psychiatric and psychological care is also important, because the disease and the related limitations as well as the nuisance of symptoms are a powerful stress factor for patients, triggering the vicious circle mechanism. Research has shown that every fifth patient with the most severe course of the disease has suicidal thoughts. Moreover, even parents of children with AD are significantly more likely to show symptoms of depression.
Antihistamines are used to treat itching. In cases where local treatment does not bring the desired results, various types of oral medications (glucocorticosteroids, cyclosporine, methotrexate) and treatment with UV radiation are used. In the event of a bacterial infection, appropriate antibiotic treatment is underdosed. A very rare, but potentially fatal, complication of AD is generalized herpes infection. Administration of intravenous antiviral medication may then be necessary.
Text: lek. Paulina Jurek
The Medonet Market offer includes an ointment for dry skin with symptoms of atopic dermatitis Konopka. The beeswax and sage leaf extract contained in it moisturize the skin and have antiseptic and anti-inflammatory properties.
Common skin diseases – read more