Atopic dermatitis or eczema is a common chronic disorder in which the skin appears inflamed, red, dry and intensely itchy. It mainly affects children.
Atopic dermatitis is due to a combination of genetic and environmental factors. Genetic causes include differences in the proteins that form part of the skin barrier. When this barrier is broken down, the skin loses moisture and becomes drier, irritated and hypersensitive. The skin is then more prone to infection, whether from bacteria, viruses or fungi. The skin’s immune system can vary and overreact to environmental triggers, such as animal hair or dust particles.
It should be noted that asthma and allergies may occur more frequently in patients with atopic dermatitis, but are not the cause of eczema.
How and where atopic dermatitis affects according to age
In young children, atopic dermatitis often starts as a red, dry rash affecting the cheeks and around the mouth, worsening with pacifier use. As the child gets older, the rash moves on to affect the arms, legs and other areas where they may scratch. In adolescents, eczema mainly affects the inner elbows and knees, hands, feet and around the eyes.
Although there is no cure, it usually improves with age and disappears in a large proportion of patients. However, there are a number of recommendations to help manage this problem.
Treatment of atopic dermatitis
The treatments recommended by dermatology experts for atopic dermatitis are aimed at preventing skin dryness, treating the rash, improving itching and minimizing exposure to triggers. In this sense, the process to follow would be:
1) Daily skin hydration to prevent dryness.
– A daily or every other day bath, with the aim of keeping the skin clean and eliminating potential irritants.
– The water should be lukewarm (not hot) and the bath should not exceed 5 – 10 minutes.
– After the bath it is necessary to dry the skin well and apply moisturizer generously.
– It is important to find a type of moisturizing cream or milk that the child’s skin accepts, otherwise it will reject its application.
– The thicker the cream, the better the barrier function and the better the skin hydration.
2) Treat the rash
The most commonly used drugs are topical corticosteroids. There are many types of them, with different potencies and formulations (ointments, creams, ointments, lotions, solutions, gels, emulsions, foams, etc.). In any case, the type of corticosteroid and its presentation will be adjusted to each individual patient, with the aim of achieving a good response and minimal side effects. In general, they should be applied as a thin layer on the skin and without exceeding two applications per day. It is exceptional to observe undesirable effects of its application if we do it as recommended by our expert doctor in Dermatology.
There is a new group of topical anti-inflammatory drugs that are very useful, especially in areas of very thin skin such as the eyelids, armpits and groin, where it is more appropriate to avoid topical corticosteroids.
For cases of severe atopic dermatitis or those that do not respond to the usual medication it may be necessary to use systemic medication. These drugs are somewhat more complex to use and need detailed follow-up by the dermatologist.
3) Treat itching
It should be explained to the physician if the child is very itchy or if it affects the quality of sleep. Oral antihistamines can help with sleep, although they do not completely relieve itching and scratching.
4) Avoid triggers
Common triggers include excessive bathing without subsequent moisturizing, low humidity, exposure to tobacco smoke, emotional stress, sweating, rubbing and exposure of the skin to products such as wool, soaps, fragrances and laundry detergents.
5) Recognize infections as a triggering factor.
Atopic children have an altered skin barrier and are therefore at increased risk of skin infections. The most common is infection by Staphylococcus aureus bacteria, which should be suspected when the skin develops crusts that look like dried honey. Infected skin can worsen eczema and some patients require topical and even oral antibiotics.