Atopic dermatitis, also called Eczema, is a common allergic skin disease that usually starts in early childhood. It can be associated with infection (bacteria, fungi, yeast, and viruses) of the skin. Atopy is a special type of allergic hypersensitivity that is associated with asthma, inhalant allergies (hay fever), and chronic dermatitis. There is a known hereditary component of the disease, and it is more common in affected families. Criteria that enable a doctor to diagnose it include the typical appearance and distribution of the rash in a patient with a personal or family history of asthma and/or hay fever.
Major and minor Characteristics of atopic dermatitis
- Characteristic rash in locations typical of the disease (arm folds and behind knees)
- Chronic or repeatedly occurring symptoms
- Personal or family history of atopic disorders (eczema, hay fever, asthma)
- Early age of onset
- Dry, rough skin
- High levels of immunoglobulin E (IgE), an antibody, in the blood
- Hyper linear palms
- Keratosis pilaris
- Hand or foot dermatitis
- Cheilitis (dry or irritated lips)
- Nipple eczema
- Susceptibility to skin infection
- Positive allergy skin tests
Is atopic dermatitis a common disease?
- Atopic dermatitis is very common worldwide and increasing in prevalence.
- It affects males and females equally and accounts for 10%-20% of all referrals to dermatologists (doctors who specialize in the care and treatment of skin diseases).
- Atopic dermatitis occurs most often in infants and children, and its onset decreases substantially with age.
- Of those affected, 65% of patients develop symptoms in the first year of life, and 90% develop symptoms before the age of 5.
- Onset after age 30 is uncommon and often occurs after exposure of the skin to harsh conditions.
- People who live in urban areas and in climates with low humidity seem to be at an increased risk for developing atopic dermatitis.
- About 10% of all infants and young children experience symptoms of the disease.
- Roughly 60% of these infants continue to have one or more symptoms of atopic dermatitis even after they reach adulthood.
- This means that more than 15 million people in the United States have symptoms of the disease.
Symptoms and signs of atopic dermatitis
Symptoms and signs may vary from person to person; the most common symptoms are dry, itchy, red skin.
- Itch is the hallmark of the disease.
- Typically, affected skin areas include the folds of the arms, the back of the knees, wrists, face, and neck.
- The itchiness is an important factor in atopic dermatitis, because scratching and rubbing can worsen the skin inflammation that is characteristic of this disease.
- People with atopic dermatitis seem to be more sensitive to itching and feel the need to scratch longer in response.
- They develop what is referred to as the “itch-scratch” cycle.
- The extreme itchiness of the skin causes the person to scratch, which in turn worsens the itch, and so on. Itching is particularly a problem during sleep, when conscious control of scratching decreases and the absence of other outside stimuli makes the itchiness more noticeable.
Causes and risk factors of atopic dermatitis
The cause of atopic dermatitis is not known, but the disease seems to result from a combination of genetic (hereditary) and environmental factors. There seems to be a basic cutaneous hypersensitivity and an increased tendency toward itching. Evidence suggests that the disease is associated with other so-called atopic disorders such as hay fever (seasonal allergies) and asthma, which many people with atopic dermatitis also have.
- In addition, many children who outgrow the symptoms of atopic dermatitis go on to develop hay fever or asthma.
- Although one disorder does not necessarily cause another, they may be related, thereby giving researchers clues to understanding atopic dermatitis.
- Many of those affected seem to have either a decreased quantity of or a defective form of a protein called filaggrin in their skin. This protein seems to be important in maintaining normal cutaneous hydration.
- It is important to understand that food sensitivities do not seem to be a major inciting factor for most cases of atopic dermatitis.
- This is an area of active research. Patients with atopic dermatitis seem to have mild immune system weakness.
- They are predisposed to develop fungal foot disease and cutaneous staphylococcal infections, and they can disseminate herpes simplex lip infections eczema herpeticum ) and smallpox vaccination (eczema vaccinatum) to large areas of skin.
- While emotional factors and stress may sometimes exacerbate the condition, they do not seem to be a primary or underlying cause for the disorder.
Skin features of atopic dermatitis
- Lichenification: thick, leathery skin resulting from constant scratching and rubbing.
- Lichen simplex: refers to a thickened patch of raised skin that results from repeat rubbing and scratching of the same skin area.
- Papules: small, raised bumps that may open when scratched, becoming crusty and infected.
- Ichthyosis: Dry, rectangular scales on the skin, commonly on the lower legs and shins.
- Keratosis pilaris: small, rough bumps, generally on the face, upper arms, and thighs. These are also described as gooseflesh or chicken skin and may have a small coiled hair under each bump.
- Hyper-linear palms: Increased number of skin creases on the palms.
- Urticaria: Hives (red, raised bumps), often after exposure to an allergen, at the beginning of flare-ups, or after exercise or a hot bath.
- Cheilitis: inflammation of the skin on and around the lips
- Atopic pleat (Dennie-Morgan fold): An extra fold of skin that develops under the eye.
- Dark circles under the eyes: May result from allergies and atopy.
- Hyperpigmented eyelids: Scaling eyelids that have become darker in color from inflammation or hay fever.
- Prurigo nodules also called “picker’s warts” are not really warts at all. These are small thickened bumps of skin caused by repeated picking of the same skin site.
Stages of atopic dermatitis
- Atopic dermatitis seems to have a differing pattern of involvement depending on the age of a patient.
- In infants, atopic dermatitis typically begins around 6 to 12 weeks of age.
- It may first appear around the cheeks and chin as a patchy facial rash, which can progress to red, scaling, oozing skin.
- The skin may become infected.
- Once the infant becomes more mobile and begins crawling, exposed areas such as the knees and elbows may also be affected.
- An infant with atopic dermatitis may be restless and irritable because of the itching and discomfort.
- Many infants improve by 18 months of age, although they remain at greater than normal risk for dry skin or hand eczema later in life.
- In childhood, the rash tends to occur behind the knees and inside the elbows, on the sides of the neck, and on the wrists, ankles, and hands.
- Often, the rash begins with papules that become hard and scaly when scratched.
- The skin around the lips may be inflamed, and constant licking of the area may lead to small, painful cracks.
- Severe eczema cases may affect growth, and the child may be shorter than average.
- In those with more heavily pigmented skin, especially the face, areas of lighter skin color appear. This condition is called pityriasis alba. It is usually self-limited and the color will eventually normalize.
- The disease may go into remission (disease-free period) for months or even years.
- In most children, the disease disappears after puberty.
- Although a number of people who developed atopic dermatitis as children also experience symptoms as adults, it is less common for the disease to show up first in adulthood. The pattern in adults is similar to that seen in children; that is, the disease may be widespread or limited.
- In some adults, only the hands or feet may be affected and become dry, itchy, red, and cracked. Sleep patterns and work performance may be affected, and long-term use of medications to treat the condition may cause complications.
- Adults with atopic dermatitis also have a predisposition toward irritant contact dermatitis, especially if they are in occupations involving frequent hand wetting, hand washing, or exposure to chemicals.
- Some people develop a rash around their nipples.
- These localized symptoms are difficult to treat, and people often do not tell their doctor because of modesty or embarrassment.
- Adults may also develop cataracts that are difficult to detect because they cause no symptoms. Therefore, the doctor may recommend regular eye exams.
ECZEMA TREATMENT & MANAGEMENT
The major goal of treatment is an improvement in your quality of life. You should be able to participate in your school, work, social, and family activities. You should feel healthy and satisfied with your skin’s appearance. There should be no social stigma attached with the condition. You should have little to no side effects from the treatments for eczema. In addition, sleep should be restful and undisturbed by the need to scratch the skin.
Avoidance of Possible Triggers
Irritants: Irritants such as chemicals, soaps, detergents, fragrances, certain fabrics, and smoke can further irritate the skin in patients with eczema.
The following are steps to perform to reduce irritant exposures:
- Wear comfortable clothing.
- Wash all new clothes prior to wearing them.
- Keep fingernails short and smooth to help prevent additional skin damage from scratching.
- Use broad-spectrum ultraviolet (UV) protective sunscreen (UV-A and UV-B with an SPF of 15 or higher)
- Bathe immediately after swimming to reduce and remove exposure to various chemicals found in swimming pools and beaches.
Inhaled Allergens: House dust mites are small, microscopic (you cannot see them with the naked eye) organisms. They are typically found indoors (mattresses, pillows, carpet), typically in areas of high humidity. These have been associated with eczema.
Foods: Common allergic foods have been associated with eczema. If you consistently notice worsening of your rash after ingesting certain foods, notify your allergist / immunologist for further evaluation. Of particular note, eliminating a variety of foods from the diet that you are not allergic to is rarely helpful in patients with eczema, so any evaluation of a possible food allergy should first be done with careful consultation with an allergist / immunologist.
Stress: Stress, including anger and frustration, can cause additional itching, thus potentially worsening the “itch-scratch cycle.”
The following treatments may be used for both adults and children.
- Topical Therapies: Topical means applying directly to your skin. There are many topical therapies:
- Ointments: Tends to have more oil than water, usually is more thick and greasy. These are the most common types of moisturizers used to treat eczema.
- Creams: A mix of oil and water, it usually looks white and smooth.
- Solutions: This is a more liquid form, feels like water.
- Lotions: This is thicker than a solution.
Dry skin tends to worsen the itching and rash. Various environmental issues, such as exposure to low humidity and wind can further dry the skin. Therefore, moisturizing (hydrating, or adding water) your skin is an important component to eczema care. After soaking your skin in a bath or shower, pat dry the skin gently (pat the excess droplets of water). Then, immediately apply a moisturizer on the slightly wet skin to “lock” in the water and thus, improve dryness.
It is important to know that moisturizers are NOT steroids. It is also important to tell the difference between steroids or other anti-inflammatory medications and moisturizers. Your allergist / immunologist can help you differentiate between them.
Best Homeopathic Treatment for Atopic Dermatitis:
Although atopic dermatitis affecting any age group and any part of the body but mainly affecting children’s and skin folding parts of the body. In homeopathy, there are many Wonderful medicines for atopic dermatitis but some medicines are used according medicine and disease symptoms as;
1. Atopic/Eczema -In the fold of neck: Hydrastis is the best medicine when atopic eruption in the fold of neck and eruptions like variola and eczema that dries into crust and burn like fire, worse from washing. This medicine should be using a dose night and morning with the application every night of one part of Hydrastis and 10 of Glycerine.
2. Atopic/Eczema -hands and weeping eczema: Mezereum should be used when eruptions on the back of hands and wrists halfway up to elbows, itching aggravated by scratching. Eruptions moist after scratching and worse from washing and if eczema weeping and fluid come out on scratching then use Graphites in higher potency in chronic cases and Lower in acute cases.
3. Atopic/Eczema-on back of hand: Bovista should be used when moist eczema on the back of hands and also it uses when eczema in the bend of the knee, this type eczema also called Baker’s eczema.
- If eczema on hand and fingers then Carb veg, Mer-s, Sepia useful.
- If Eczema of hands and wrist one attack hardly subsiding before another set in and oozing out when using hands and intolerable itching and soreness with dyspepsia and cough with swelling of gland then the best suitable medicine is Juglans cinerea.
4. Atopic/Eczema-alternating with asthma: if eczema alternating with asthma and found these peculiar symptoms as;
- – Asthma worse in winter
- – Vomits during attack and is better after that.
- – Frequent colds and cough
- – Vaccinations more than ones.
- – Asthma alternating with eczema. Then the best suitable medicine is Thuja 200 ch in 3 doses to be given 4 hrs apart. Next day Ipek in repeated dose.
5. Atopic/Eczema -itching and recurring: Anacardium should be used when intense itching eczema .when repeated recurrence of eczema with bleeding cracks and the patient feels pleasure while scratching then use streptococcin.
Along with these above medicines there are some other medicines which are also useful in atopic treatment as Ant. Crud, Nat mur6x, Ars alb, Dulca, And Rhus Tox.