
Atopic dermatitis is a common skin condition, especially in paediatrics, currently affecting almost 20% of children. Although it’s symptoms usually disappear as the patient gets older, there are also adults affected by this pathology. Today, Dr Enrique Herrera Acosta, explains what atopic dermatitis is and offers us some practical advice on its treatment, prevention and how to act when faced with this condition.
What is atopic dermatitis?
It is a chronic skin pathology that causes itching and inflammation of the affected areas and gives rise to eczema of different consideration, which, also, leads to other lesions as a result of scratching. After a while, it can be translated into thickening and chronic dryness of the skin. It also psychologically affects the patient, with increased irritability, nervousness and difficulties in having adequate physical rest. It is, therefore, a significant problem for the quality of life of those who suffer it.
What are its main causes?
It is mainly a genetic disease, with the patients showing an individual predisposition to it, meaning they often have a family history of atopic dermatitis. However, whether the genetic factor is triggered or not depends on some external factors, such as very cold and dry environmental conditions. The existence of food or textile allergies further aggravates the situation.
Who does it affect? Does it affect everyone equally?
The initial outbreaks usually appear in the first months of life. Almost 20 per cent of children suffer from it. It is usually diagnosed in childhood and in most cases, tends to disappear as the patient is approaching adulthood; however, there are also reported instances of debutant adults with atopic dermatitis.
Is there a way to prevent atopic dermatitis?
There is no cure, nor unique treatment. However, the effectiveness of preventive measures and good personal care of atopic skin is proven. The personalised diagnosis by a dermatologist is essential, so when outbreaks or significant lesions occur, the patient can receive the appropriate treatment and specific pharmacological prescription with the correct dosage.
What treatments or recommendations would you give to prevent its occurrence?
Indoor places with dry air should be avoided by those suffering from atopic dermatitis. That is why it is important to maintain proper hydration of the skin. Atopic dermatitis entails a weakened skin barrier, which is why the lack of moisture in the air favours the extreme dryness of the skin, which tends to crack and increases the likelihood of eczema and skin lesions typical of the disease.
Too low temperatures are also not good, because it also reduces hydration, reduces the generation of skin fat and further weakens such vulnerable skin. Cold also increases the feeling of itching, the patient scratches more, and secondary injuries worsen.
People who suffer from atopic dermatitis should wear 100% cotton garments, avoid sudden changes in temperature and use specific hygiene products, which the dermatologist recommends in each case.
The showers or baths can not be very long and the water should be warm. The shower gel should be mild, it is also advised to use shower oils. Do not exfoliate or use abrasive products. The skin should be dried without rubbing it with the towel, rather pat drying it.
Another thing to bear on mind is, as silly as it might seem, to keep your nails short and trimmed; the idea is to avoid scratching at all cost, but sometimes it happens unconsciously, for example, while you sleep, and the shorter the nails are, the less aggression will be produced over the affected area.
How should atopic skin be treated?
Using ointments or creams with corticosteroids is the general treatment in cases of mild-moderate outbreaks. As for maintenance and topical corticosteroid creams, there are inhibitors of Calcineurin, Tacrolimus and Pimecrolimus, which dermatologists use extensively during in-between outbreak periods.
When the extent of eczema is considerable, treatment resorts to cycles of oral corticosteroids. If the patient requires several cycles per year or stops responding to corticosteroids, it is necessary to consider choosing immunomodulatory drugs, other than corticosteroids, such as cyclosporine, mofetil mycophenolate, azathioprine, methotrexate…
Currently, there are also very encouraging results with biological drugs, such as Dupilumab, Omalizumab or Ustekinumab, which are used for other skin pathologies and could be effective in patients with severe atopic dermatitis.
What are the differences with other types of dermatitis, such as seborrheic or contact dermatitis?
Seborrheic dermatitis – is a skin disease also with a genetic predisposition, but can also be caused by fungi or excess of sebaceous glands. The lesions appear on the scalp and face, with noticeable redness and flaking. This fact makes a big difference from atopic dermatitis which can affect the whole body: the face, the flexion areas of the neck, arms and legs, meaning the folds of elbows and knees, and, in adults, damage appears in almost any area of the body.
Contact dermatitis. It is the skin’s response to contact with a particular substance, whether in food, textile or object… It does not have to be an allergy, but it can be a clue that there is an allergy.
Now in summer, what special recommendations should be given during hot months?
First of all plenty of moisturising, the more the better, but not over the areas affected by an outbreak of dermatitis. Moisturising is a preventive measure, to avoid irritations. When there are outbreaks, skincare will depend on the specific recommendations of the dermatologist.
When it comes to showers and baths, the recommendation is to do it in moderation. They should not be too long, in very cold or very hot waters.
Sun exposure is often a good ally in the treatment of eczema, so we sometimes use artificial narrowband ultraviolet radiation to control outbreaks. Still, always in moderation and without getting burned.
On the other hand, during outbreaks, you have to be careful with swimming pools because chlorine dries the skin very much, and for that reason, it is necessary to rinse your skin well after bathing — it is a good recommendation for everyone, but much more for people with atopic dermatitis. On the contrary, seawater is recommended because it enhances the beneficial effects of the sun.
Can atopic dermatitis be cured?
As it is a genetic disease, the answer is no. The medication can alleviate symptoms, depending on the severity of the cases. However, symptoms can disappear by itself with the progress of each individual, or attenuate with time, but there is no treatment to cure it.