ATOPIC DERMATITIS

Atopic Dermatitis (AD) is a disease that causes itchy, inflamed skin. Typically affects the elbows, behind the knees and face, but can affect other parts of the body. It is often associated with, asthma and allergy.

Food allergies play a role. Several studies have concluded that consuming eggs, cow’s milk and some nuts may cause acute flares of atopic dermatitis, especially in young children. An increased IgE binding to Staphylococcus aureus has been found. Staphylococcal interaction of antigen and specific anti-staphylococcal antibodies can induce the release of mast cells, causing itchiness and aggravating dermatitis. The combination of all these result in a deficit in the production of skin ceramides. Ceramides are a family of natural lipids through which cells remain united and strong. With fewer ceramides due to atopic dermatitis, there is a decrease of defense function of the skin, which can cause swelling, itching, redness and dryness.

Babies can develop red, oozing, crusted lesions on the face, scalp, in the diaper area, hands, arms, feet or legs. Usually, dermatitis disappears at around 3 to 4 years of age, although it often reappears.

There may be very intense and prolonged itching that frequently produces emotional disorders, which may have been misinterpreted as the cause. The lesions are characteristically distributed, invading the face, neck and upper trunk ("hood mono"). It also attacks the folds of the elbows and knees. In infants, the rash begins on the cheeks and is often vesicular and exudative. In children it is dry. (Looks and feels like leather) Adults often have leathery, hyper or hypo pigmented lesions.

Sometimes it is not easy to diagnose because there are many simulators such as psoriasis, bacterial eczema, cutaneous lymphomas etc.

A correct diagnosis of atopic dermatitis in infants and small children is very important, especially when starting off with a treatment. The patient must have at least three or more of the following characteristics:

• The first episode appears before the age of two.
• Parents have a history of dry skin or eczema; or other allergic conditions (especially if the patient is younger than four years).
• The baby has a history of dry skin, which will make it more prone to eczema or has previously developed eczema or other atopic conditions.
• In young children, the appearance of lesions in the skin folds is very common. On babies, lesions appear on the face, trunk and extremities.

There is no cure, but outbreaks can be kept to a minimum by taking preventive measures. Certain measures should be taken to reduce the intensity and frequency of these outbreaks. In case of an outbreak, topical corticosteroids are indicated along with topical antibiotics due to the involvement of Staphylococcusaureus in this pathology. It is essential to use it daily with emollients, preferably after showering or bathing. The use of oral corticosteroids and other immune modulatory drugs; would be prescribed in more severe cases.

A good choice for the treatment of AD once the acute dermatitis has improved is the use of topical tacrolimus (immune modulators) under medical supervision.

Temporarily changing habits to solve an outbreak or hospitalization.

Optional Treatments : RUVA-UVB ultraviolet rays.

Systemic Immune supressors in severe cases.

All the circumstances that produce itching in normal conditions must be avoided. These measures include:

• Ambient temperature: heat is poorly tolerated by patients with atopic dermatitis.
• Humidity: Environmental humidification is beneficial.
• Sun Exposure: usually proves to be beneficial in atopic dermatitis, but you should always avoid sunburn.
• Clothing: Avoid direct skin contact with wool, plastic, rubber, etc. Food: some acidic foods such as citrus and tomato can irritate the skin. Coffee, cocoa and alcohol increase itching and are counterproductive. Some foods that contain histamine or release this substance, especially if consumed in large quantities (strawberries, shellfish), can also trigger itching.
• Hygienic: Bathing or showering especially in very hot water and using soaps with detergents increase xerosis and irritate the skin. It is best to shower with warm water and use an acid pH gel.
• Emollients: Moisturizing the skin one or several times a day using an emollient cream throughout the body is an essential step in the treatment of atopic dermatitis. The most appropriate time to apply the cream is immediately after showering or bathing. It should be noted that many atopic patients have poor tolerance to some of the most commonly used compounds in this group, such as urea.
• (UVA-UVB) Immune-suppressive treatments.