Atopic dermatitis (also known as atopic eczema or atopic dermatitis) is an inflammatory skin disease characterized by an erythematous, papular, vesicular rash with dry, scaly lesions and is very itchy. It progresses in relapses, often interspersed with calmer periods when the lesions are minimal but still present. Pruritus (itching) is often associated with sleep disorders. Sometimes oozing may exist, and scabs may appear.
Red patches usually appear between the ages of 3 months and 5 years. It is estimated that twenty percent of babies develop this disease. It starts initially on the cheeks, forehead and neck, may spread to the scalp, more rarely spreading to the chest and flexor folds.
This skin disease often appears to be allergic in origin, and in 80% of cases it improves by the age of 3 to 5 years, and only a few percent of adults have it.
Causes
The origin of this skin disease is not really known: atopic dermatitis is a complex disease:
- there is a strong genetic component (if both parents had this disease, the child has a 50/50 chance of having it),
- a weakened immune system can cause the disease to appear as a result of another infection, such as ENT,
- Excessive hygiene would seem possible (*): too sterile and too clean an environment, this disease is more common in societies where contact with bacteria is less frequent (fewer cases in the countryside than in the city),
- certain foods such as eggs, nuts, ... would favour its appearance,
- certain allergens also: pollens, animal hair, dust mites, detergents, ...,
- a humid climate, stress and sweating would increase the onset of the disease.
(*) "The increased prevalence of atopic dermatitis in populations with a high standard of living has been linked to decreased exposure to infectious agents. This observation has led to the hygienic theory that suggests that the decrease in infections is responsible for changes in the regulation of the innate immune system. "See: www.sfdermato.com
Symptoms
The disease progresses in relapses, with periods when lesions are minimal but still present. There are 4 stages in the progression of the disease:
- phase 1: this is the erythematous phase, the skin is red, with the appearance of small blisters and itching (pruritus),
- phase 2: the vesicles come together,
- phase 3: the vesicles exude,
- phase 4: appearance of crusts that fall off and leave a red skin,
- ...and return more or less quickly to phase one.
There are also differences in the location of the disease according to age:
- children under two: cheeks, scalp, chest, shoulders and thumbs,
- children from 2 years old to teenagers: knees, ankles, wrists and elbows. Lichenification (thickening of the skin) is a frequent symptom and indicates persistent localized pruritus.
- In adolescents: flexing folds of the limbs, around the eyes, on the soles of the feet. The majority of atopic dermatitis disappears in adolescence. When it continues, lichenification and xerosis are common. Then, damage to the face and neck, in the form of erythema, is characteristic.
- in adults: neck, ankles, feet and hands.
Beware of complications!
There may be colonisation of the skin by certain bacteria or viruses, particularly due to scratching during phase 1, when it itching occurs.
Staphylococcus aureus, among others, can colonize the damaged skin; the herpes virus can also spread to the affected areas. It is therefore necessary to keep an eye on the patient, to keep nails and hands clean, to keep the patient away from a person with herpes, ...
In very severe cases, stunted growth may even be observed (stagnation or break in the stun-weight curve). These delays can be recovered by effectively treating the patient.
Diagnosis
It will be based on questioning (for children, adolescents and adults, parents for the youngest) and clinical examination of the patient: evidence of the symptoms seen above, including the compulsory criterion of the presence of itchy skin associated with 3 or more of the following criteria:
personal dermatological history of damage to the flexor folds, cheeks, neck or anterior aspect of the ankles,
a personal history of dry skin (xerosis) in the first year,
personal history of asthma or rhinitis (or family history in small children),
Dermatosis of the folds, cheeks, forehead, and the outer face of the limbs in children under 4 years of age.
onset of signs before the age of 2 years.
A biopsy of a piece of skin is not essential to make the diagnosis. However, under the microscope, we would see an infiltrate of lymphocytes, monocytes and eosinophilic polynuclear cells around the small vessels and capillaries.
An allergological exploration may be necessary and useful, as there may be a possible role of allergens as perennant factors in some atopic dermatitis in babies and children.
Treatments
Treatment of atopic dermatitis is symptomatic.
First of all, the identification of allergenic agents may be sufficient (sensitization to dust mites is often found) for the disease to regress and disappear with the eviction of the responsible allergen, but the extent of the allergy possibilities makes the result random and the results can be disappointing, moreover these eviction measures do not show a convincing clinical effect.
Various treatments, aimed at reducing inflammation and alleviating itching, can be used:
- corticosteroid ointments under strict medical supervision during flare-ups to reduce inflammation and itching,
- anti-histamines in case of pruritus (their sedative action will allow young children to sleep, and not to scratch at night),
- calcineurin inhibitors: these molecules of the macrolide family have an immuno-suppressive action by inhibiting calcineurin (molecule: Tacrolimus, its anti-inflammatory effect is similar to a dermocorticoid of medium to high potency, but it has a better local tolerance, allowing its use on surfaces usually contraindicated to dermocorticoids (e.g. the face)),
- antibiotics: necessary if a bacterial (impetigo) or fungal infection colonizes the eczema plaque.
- thermal cures,
- emollients: used during the acute phase and intended for xerosis areas, e.g.: ROC ENYDRIAL EXTRA EMOLLENT BODY BALM BATH
- a product recommended to calm itching: EUCERIN (ONAGRINE) PRURITOL SPRAY SOOTHING.
Prevention and advice
First of all, as seen above, to avoid an aseptic environment, the baby must be able to quickly activate his immunity by putting him in contact with "friendly" bacteria such as those that naturally colonize our digestive tract, our skin, etc ...
Hygiene advice is important:
- washing with soap-free vegetable soaps or vegetable bars
- Use of emollient creams on affected areas,
- Avoid woollens on the body (wool is irritating.) and prefer cotton and silk,
- avoid aggressive soaps,
- Apply protection (compresses) to itchy areas,
- Avoid mites, mould, tobacco, pets (cat, dog, ...),
- avoid allergenic foods. The foods most involved in infant food allergies are milk, eggs, peanuts, soy, fish, legumes, wheat, and cereals such as rye, wheat, barley, oats, spelt, (the avoidance of an allergen is only justified if its role in an allergic reaction is proven, so as not to cause a source of nutritional deficiency),
- vaccinate the child normally (to avoid the aggravating role in infections), but it is prudent to temporarily delay vaccinations during strong outbreaks,
- avoid early dietary diversification
- Avoid scratching, as it aggravates the lesions; for small children, it is important to avoid scratching.
For children and infants, cut nails short to prevent scratching and infection of the lesions.
In most cases, the disease subsides and usually disappears by the age of 3 to 5 years. Less than 10% of cases may persist into adulthood.
As far as treatment is concerned, only a doctor will be able to help the patient choose the most appropriate treatment.