Atopic Dermatitis is a common allergic skin disorder, seen more frequently in young children, but does extend into adulthood too. It may begin in the first one year of life or at any time in childhood. There is a strong family history of allergies, for example asthma, hay fever, allergic rhinitis (sneezing, cough and cold), eczema, or food allergies and history of eczema or atopic dermatitis in the family members. Consult with Dr Jastinder Gill, your Skin Specialist in Ludhiana, to talk about your skin allergies in more detail.
Presentation/Sign and Symptoms of Atopic Dermatitis
Atopic dermatitis presents as dry, itchy skin patches which may later change into eczematous lesions. It commonly affects the face, neck, arms and legs, but spares the body folds such as underarms and groins. In infants it usually appears on the cheeks as red, itchy patches, in the first year of life, but later can extend to the body parts too. The disease goes through phases of remission and relapses, it follows a long course. There may be weeks to months of no sign and symptoms and suddenly the disease flares up.
Diagnosis of Atopic Dermatitis
Your doctor will take a detailed history, do a full physical examination and come to the diagnosis. There are no definitive blood tests to diagnose atopic dermatitis. The diagnosis is established by physical examination of the skin lesions, family history of allergies, early onset of disease and frequent relapse and remissions. Though your dermatologist, may advice a few blood tests and in some cases a skin biopsy, to reach a conclusion and rule out other skin disorders. A swab may be taken from the skin to rule out or establish a superimposed skin infection. As bacterial infections are common in patients of atopic dermatitis especially in children.
Triggers
As atopic dermatitis is a chronic condition and goes through a course of relapse and remission, there are a few triggers or aggravating factors which can lead to flares up of the skin lesions. It may be difficult to find the aggravating factors, but one must try to identify the triggers, which will help to control and manage the condition well. The outcome of treatment will be much better, the relapses or flare ups, can be prevented and can be managed well in time, by removing the aggravating factors, the remission phase can be prolonged. The severity of the disease can be also controlled.
The various non specific triggers or aggravating factors can be
- Harsh soaps
- Detergents
- Abrasive fabrics like wool and synthetic
- Tight fitting clothes
- Extremes of temperature, extreme summers and winters
- Sudden changes in temperature, say from air conditioned room to outdoors and reverse
- Humidity
- Air borne irritants like pollution, smoke, pollen, dust, tobacco
- House dust and dust mites
- Food allergens, especially in children
- Environmental allergens like pollen especially in the flowering season
Treatment and Management of Atopic Dermatitis
Timely and appropriate treatment goes a long way in the management of atopic dermatitis. Once your dermatologist diagnoses the condition as atopic dermatitis, its essential for the care provider at home to understand the treatment well. Discuss with your doctor in detail about the condition, do not hesitate, any doubts or questions need to be discussed, as your doctor is the best person to guide you and help you with all your questions. I give written plan of care to my patients, for them to have as a ready reference to go back home and read.
Non Medical Measures You Can Consider
The non medical measures are the backbone for the management of atopic dermatitis, they will help in long remission periods, will also prevent the severity of the disease.
- Once a day bath with Luke warm water and mild soap, is essential for the good management of atopic dermatitis, as it cleanses the body and the water hydrates the skin.
- Avoid harsh soaps, as they irritate the skin and damage the skin barrier. No foam bathing soaps.
- Do not take hot water showers/baths, hot Water too irritates the skin and damages the skin barrier. An intact skin barrier is essential to protect the skin, it keeps all the skin irritants and allergens at bay.
- Use of an appropriate moisturiser regularly, is the key to the treatment and management of atopic dermatitis. The skin barrier which mainly comprises of lipids, is often damaged in patients of atopic dermatitis and this leads to exacerbation of the disease. A moisturiser rich in ceramides, squalene, phytosterols etc, helps protect and repair the skin barrier. I cannot emphasise enough the importance of a moisturiser. I usually tell my patients, if you use an appropriate moisturiser regularly and religiously, you have won the disease, you will have long disease free time.
- Use pure and soft cotton fabric clothes. No woolen or synthetic clothes to touch the skin.
- Room temperature to be set at at appropriate temperature. Use of high temperatures in winters and very low in summers will not be good for patients of atopic dermatitis .
- Use of humidifiers. If the indoor air is very dry, then it will lead to dryness of the skin and hence a flare up of atopic dermatitis. The use of humidifiers, especially in places of air conditioning is the need for atopic patients. If a humidifier is out of budget or is not available, then even placing a bowl of water in the room, helps significantly to maintain the indoor air humidity.
- Wash clothes with mild detergents. No bleach or fabric softeners to be used.
- Extra rinse the clothes with water to wash away all traces of the detergent from the clothes. As the detergent left behind on the clothes will lead to skin irritation, especially where the clothes are in close contact. You can use the rinse option of the washing machine or use bucket for the extra rinse with water.
Medical Measures to Control Your Skin Allergy
For the control of active disease, when there are flare ups. Your dermatologist will assess the skin and then accordingly advice you the treatment. Continue with the non medical measures as mentioned above and start with the medical measures.
- Moisturisers are the mainstay of the treatment, along with the medical treatment, you need to use the moisturiser, that’s why the mention of them is the point number one in medical management. May be your dermatologist change your moisturiser depending upon the skin requirement, as lotions are given in the maintenance phase, but if the skin is very dry then lotions may not work, may have to use oil and cream based moisturiser.
- Topical steroids are the treatment of choice in managing the fare ups in atopic dermatitis. Do not fear the steroids, but understand their use. Discuss with your doctor, clear all your doubts and questions. The use appropriate use of steroid creams under the guidance of your dermatologist will help you in long disease free periods. But yes if used indiscriminately without the guidance of a dermatologist, they can cause more harm than good.
- Immunomodulators, have helped us with the better management of atopic dermatitis and also have decreased the use of topical steroid creams.
- Biologics, is another class of drugs, now available for resistant cases.
- Probiotics play an important role in atopic patients.
- Antibiotics are added to the treatment plan, in case of superimposed skin bacterial infections.
Maintenance
Atopic dermatitis is a chronic disease, with long and frequent periods of relapses and remissions, hence the importance of maintaining long periods of remissions, with fewer relapses and to keep the check of the severity of the disease will help in leading a good quality life.
- Follow the non medical measures as mentioned above.
- Identify triggers
- Follow your doctor’s advice,
- Understand not only the treatment and management, but the disease too.
- Be regular in your treatment
- Follow the treatment plan, as explained to you by your doctor.
- Regular and timely follow up with your doctor is the key to the management.
- Stress free and healthy lifestyle both by patient and the family, especially for parents of children with atopic dermatitis. As it takes a toll on the parents and family too who’s taking care of the atopic patients.
For further management, you can consult Dr Jastinder Gill, your Skin Specialist in Ludhiana, online for a second opinion.