Atopic Dermatitis/eczema

Atopic dermatitis, commonly known as atopic eczema, is a prevalent and pruritic skin disorder with a significant hereditary predisposition. Over the past three decades, its prevalence has notably increased, particularly in developed countries, potentially linked to modern lifestyles and urbanization. In Northern Europe, the occurrence of atopic eczema in children has been reported to reach as high as 20%.

This condition may exhibit exacerbations under stress, during seasonal changes, or even without apparent triggers. While atopic dermatitis often subsides gradually, it can recur at later ages or persist throughout life.

Symptoms of atopic dermatitis can vary depending on the age group:

• In infants under one year old, atopic eczema typically presents as widespread skin lesions characterized by small papules, dryness, scaling, redness, and scratch marks.
• Toddlers and preschoolers may manifest localized and thickened eczema, frequently affecting joint areas, wrists, elbows, ankles, knees, and sometimes the genital region.
• Older children often experience eczema in the elbow and knee folds, eyelids, earlobes, neck, and scalp. It may also manifest as itchy blisters on the palms, fingers, and occasionally on the feet, along with scattered coin-like eczematous areas on the body.
• In adolescents and adults, atopic dermatitis can exhibit diverse patterns, with chronic local involvement frequently observed on the hands, eyelids, skin folds, nipples, or a combination of these areas.

The development of atopic eczema involves a complex interplay of hereditary, immune, metabolic, neuroendocrine, and infectious factors. Stress, weather conditions, allergens (such as dust, animal wool, and certain foods), exercise, certain foods, clothing, infections, and sun exposure are among the factors that can worsen or trigger flare-ups, with varying degrees of sensitivity in different individuals.

Complications associated with atopic dermatitis include neurodermatitis, characterized by long-term itching and scratching that leads to lichen simplex chronicus (hardened, leathery skin). Scratching may also cause skin breakage and subsequent infections. In severe cases, atopic dermatitis can affect the eyes and potentially cause permanent damage.

The mainstay of treatment for atopic dermatitis involves topical steroids, which effectively alleviate symptoms. However, it is crucial to use these medications cautiously, for a limited period, and only during active disease manifestations to avoid complications. Non-steroidal topical treatments, such as tacrolimus and pimecrolimus, may be prescribed in specific cases.

Additional treatments may include oral antihistamines to improve sleep quality, chlorine baths to reduce bacterial infections, and, in certain situations, oral steroids or antibiotics.

Preventing atopic eczema involves avoiding exacerbating factors, such as irritants, strong soaps, excessive heat, sweating, and allergens. Continuous moisturization and post-bathing skincare are essential measures to manage the disease effectively. Seeking medical advice is crucial for an accurate diagnosis and personalized treatment plan.