Atopic Dermatitis

Atopic dermatitis refers to the chronic and itchy skin condition which is more prevalent in children but can occur at any age. It is also known as eczema and atopic eczema.

People with atopic dermatitis often exhibit the "atopic tendency", which means that they develop all or some of the following conditions: atopic dermatitis, hay fever (allergic rhinitis), and asthma. These conditions also have genetic components and may run in families (a parent, sibling, or child may also be affected). A family history of eczema, asthma, and hay fever can help to diagnose atopic dermatitis in infants, especially.

Atopic dermatitis varies in appearance between individuals. From time to time, the majority of individuals with this condition have acute flares with red, inflamed, and sometimes blistered patches. In between the flares, skin appears normal or is affected by chronic eczema in the form of dry, thick, and itchy areas.

Atopic Dermatitis in Infants

In infants younger than one year old, eczema is distributed across a large surface area. The skin appears dry, scaly, and red with small scratch marks caused by nails. The cheeks are the first area affected by eczema. The napkin area is usually unaffected due to moisture retention from nappies.

Atopic Dermatitis in Toddlers and Pre-Schoolers

In toddlers and pre-schoolers, eczema becomes more localised and thickened. Eczema affects the outer side of joints, especially elbows, wrists, knees, and ankles. As the child becomes older, eczema starts affecting flexor surfaces of joints and less extensor surface is involved. The affected skin becomes dry and thickened due to constant rubbing and scratching.

Atopic Dermatitis in School-Age Children

School-age children exhibit a flexural pattern of eczema. Elbow and knee creases are affected the most. Other susceptible areas may include the neck, scalp, eyelids, and earlobes. This age group can also develop recurrent acute itchy blisters on fingers, palms, and feet. In most cases, eczema tends to improve with age and may clear up during the teenage years; however, the barrier function of the skin will never be entirely normal.

Atopic Dermatitis in Adults

Adults with atopic dermatitis exhibit various patterns of eczema. Their skin is often drier in comparison with affected children. Localised eczema persists, occurring on the hands, eyelids, and flexures. Atopic dermatitis is a major contributor to occupational irritant contact dermatitis, which usually affects hands that are frequently exposed to solvents, detergents, and water. Adults with hand dermatitis often have dry and thickened skin with blisters.

Prevalence and Onset

Atopic dermatitis affects approximately 15 to 20% of children. It is not possible to predict whether eczema will improve with time. The onset of atopic dermatitis is usually before 2 years of age. It tends to worsen between two and four years of age and then improve thereafter.

Occupational Triggers

Certain occupations that involve domestic duties, hairdressing, farming, and cleaning are sources of exposure to various irritants and allergens that aggravate atopic dermatitis. Patch tests are recommended in order to identify the source of exposure.

Treatment

Treatment of atopic dermatitis can take from several months to years. General measures include reduction of exposure to trigger factors when possible, frequent use of moisturisers, and application of topical steroids as prescribed by a dermatologist.

In some cases, management of atopic dermatitis can include the following options: antibiotics, oral corticosteroids, Methotrexate, Cyclosporine, Mycophenolate Mofetyl, Dupilumab, antihistamines, crisaborole ointment, Pimecrolimus and Tacrolimus applied topically, and phototherapy.