Atopic dermatitis
Dr. Silke Bianca Kirchschläger Nieto
What is atopic dermatitis?
Atopic dermatitis (AD) is a common chronic skin disease that can affect people of any age. It is characterized by inflammation, which leads to dry skin with a tendency for scaling and itching. It is also associated with recurrent outbreaks of eczema, which are areas of the skin that become rough, red, and often intensely itchy. The clinical course can vary greatly, and improvement is often seen with age.
It is a multifactorial disease, meaning it is caused by several factors occurring simultaneously. There is a clear genetic predisposition, as up to 70% of patients with AD have family members with “atopy” (they may have AD or respiratory conditions such as asthma, which is sometimes related to allergies to pollen or food).
What are the symptoms?
Signs and symptoms can vary from person to person and include:
- Dry skin
- Itching, which is usually intense and worsens at night
- Scaling of the skin
- Eruptions or eczema (areas of rough, red skin that can vary in color depending on the patient’s skin tone)
- Thickening of the skin
- Scratching lesions (fissures, which can sometimes bleed and become infected)
How is it diagnosed?
The diagnosis of AD is clinical, based on the physical examination by a healthcare professional familiar with the condition (pediatricians, dermatologists, family doctors, etc.). In most patients, additional tests are not necessary.
In rare cases, other studies may be needed (such as allergy testing if worsening of eczema is observed after consuming a specific food).
What can I do to prevent and treat it?
There is no curative treatment for AD, so the goal is to maintain good disease control and improve the patient’s quality of life.
General skin care is vital to prevent flare-ups and can be summarized in the following recommendations:
- Adequate skin hydration with emollients (ideally after bathing and at least once a day). There is a wide range of products available on the market with variability in size and price. It is important to note that during an outbreak, moisturizers should not be applied to the eczema, as this may increase itching. Specific treatment creams should be applied to the eczema. “Healthy skin is hydrated, diseased skin is treated.”
- Prefer showers over baths, using lukewarm water. If bathing, avoid prolonged exposure (ideally no more than 5-10 minutes). Use mild soaps specially formulated for atopic skin and apply them only to the dirtiest areas at the end of the bath. Gently pat the skin dry without rubbing.
- Do not use fabric softener in the laundry and avoid contact with any perfumes or substances that may cause itching.
- Avoid wool and synthetic fibers, and prefer cotton or linen clothing (especially for garments in direct contact with the skin).
- Avoid excessive bundling or tight-fitting clothes.
- Keep the child’s nails short and clean to prevent scratching injuries and possible infection.
When should I consult a doctor?
During an outbreak, specific treatment creams should be applied to the eczema. Corticosteroid creams (anti-inflammatory) of varying potency depending on the location and intensity of the eczema are commonly used. Other available medications are immunomodulators (pimecrolimus and tacrolimus).
These treatments, when applied early and under medical supervision, are safe and effective, and they can prevent the progression of the outbreak. Therefore, the fear of corticosteroid creams should be avoided as long as they are used appropriately and for the duration prescribed by the doctor.
Oral antihistamines can also be used to relieve itching.
“Healthy skin is hydrated, diseased skin is treated.”
