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What is Atopic Dermatitis?

  • Chronic, relapsing
  • Pruritic (itchy)
  • Non-contagious
  • Inflammatory skin condition
  • Known hereditary component, more common in affected families.
  • Affects 10-20% of children and 1-3% of adults in industrialized countries
  • Occurs most commonly in infants and children, onset decreases substantially with age. 
  • Unlikely to develop in patients older than 30 yrs.
  • There is no cure. It can be controlled with preventive measures and medicines.
  • It is estimated that 75% will improve by the time children reach adolescence, whereas 25% continue to face the symptoms through adulthood.

Symptom
 
  • Vary with the age of patients.
  • Infants- Face, scalp, legs and arms. Red, scaly, oozing, crusting rash.
  • Older children- Elbow and knee flexures, sides of neck, wrist and ankle. Dry, thick, scaly skin with persistent itching.
  • Adolescents- Flexural. Thick, lichenified leathery and dull-looking lesions .
 
Associated disorders
 
  • Allergic contact dermatitis
  • Drug sensitivity
  • Food allergy
  • Alopecia areata
  • Urticaria

Diagnosis
 
  • No Diagnostic test
  • Physical examination
  • History- allergies and asthma in family

What makes Atopic eczema worse?
 
  • Exposure to pollen, mold, dust
  • Cold and dry air in the winters
  • Colds or flu
  • Contact with irritants and chemicals
  • Contact with wool
  • Dry skin
  • Emotions and stress
  • Exposure to too much water- taking long/frequent showers, swimming too often
  • Sudden temperature change
  • Fragrances or dyes in skin lotions or soaps
 
Skin care at home- Eczema remedies
 
  • Keep the skin moist using creams or lotions 2-3 times daily. moisturizers should be free of alcohol, scents, dyes, fragrances, or other chemicals.
  • Keep your child's fingernails cut short. consider night gloves if nighttime scratching is a problem.
  • Use gentle body washes and cleansers instead of regular soaps.
  • Short, cooler baths are better than long, hot baths
  • Apply lubricating creams and lotions while the skin is damp.

How to cure Eczema?
 
Moisturizers
 
STEROIDS
 
Ointments for eczema
  • Provide lubrication and occlusion
  • Dry, thick, hyperkeratotic lesions
  • Occlusive nature improves steroid absorption
  • Should not be used in hairy or intertriginous areas-groin,axilla
  • Greasy- poor patient compliance
 
Creams for eczema
  • Less potent than ointments of the same medication
  • Acute exudative lesions respond because of their drying effect
  • Can be used in intertriginous areas
 
Lotions for eczema
  • Contain alcohol- drying effect on oozing lesions
  • Hairy areas

 
 
Potency of topical corticosteroids
topical steroids classification
 
Grade 5,6 used in children

 
Amount of cream to apply
 
  • FTU may be helpful to know how much cream to apply
  • FTU (Finger tip unit)- amount of ointment/cream expressed from a tube with 5mm diameter nozzle, applied from the distal crease to tip of index finger of an adult.
  • 1 FTU is enough to treat area of skin twice the size of flat of an adult's hand with fingers together.
  • 2 FTU = 1 gm of topical
ftu3
 
 
Absorption of topical steroids
 
Absorbed at different rates from different parts of body
  • Forearm 1%
  • Armpit 4%
  • Face 7%
  • Eyelids and genitals 30%
  • Palm 0.1%
  • Sole 0.05%

Side Effects of topical corticosteroids
 
  • Skin thinning
  • Stretch marks
  • Easy bruising
  • Telangiectasias
  • Susceptibility to skin infection

Immunosuppressants 

  • Calcineurin inhibitors- Tacrolimus and Pimecrolimus
  • Not approved for children younger than 2 yrs
Oral
  • Antihistamines- diphenhydramine and hydroxyzine
  • Steroids
  • Antibiotics- to treat infected rash
 
Phototherapy- NBUVB