Atopic dermatitis is the most common type of childhood eczema. Atopic dermatitis can have a significant impact on a patient’s quality of life, and it currently affects 15% to 30% of children.1 This condition has been one of the few diseases that has seen a significant rise over the last 30 years.
Background
Atopic dermatitis is a chronic condition characterized by itch, inflammation, and dryness of the skin. Both genetic and environmental factors are likely involved. It is a chronic condition that waxes and wanes. Flares, where the condition temporarily but quickly worsens, are very common in this condition, and managing these flares is critical.
Atopic dermatitis is prevalent in children and usually presents before the age of five.2 It can cause significant stress for the child, but also parents and caretakers as well. Many (but certainly not all) cases of atopic dermatitis wane after adolescence. There is mounting evidence that supports the hypothesis that atopic dermatitis may progress into other forms of atopic disease, such as allergic rhinitis (commonly known as hay fever), asthma, and sometimes food allergies. However, the mechanisms are still not precisely understood.3
Symptoms
Specifics and severity of atopic dermatitis will vary widely from person to person, but the main symptoms that characterize atopic dermatitis are:
- Dry skin
- Itching
- Thick, cracked, scaly skin
- Brownish patches of skin where it is affected
- Weeping skin, raw, or swollen
- Possibility of infection
Commonly affected sites:
Infants: Scalp, cheeks, arms, legs, often widespread
Children: Creases behind the knees and elbows, ankles, wrists
Adolescent/Adult: Neck area, hands
While it’s not life-threatening, it causes considerable frustration to the child and parent and may make sleeping a challenge. It’s important to get diagnosed by a family doctor or a pediatrician so that they can confirm the diagnosis and help you set up an effective management and treatment plan. Finally, some complications arise from atopic dermatitis that is important to address.
- Infections – arising from exposed skin and damaged immunity.
- Sleep problems – don’t underestimate how important sleep is.
- Itch-scratch cycle – itching damages the skin, triggering a cycle of worsening skin.
- Atopic march – may trigger other “atopic” diseases like asthma and hay fever.
Management
With atopic dermatitis, there is considerable overlap between management and treatment. The main goals of management are to prevent and minimize the chances of flares and keep symptoms under control. An important aspect of prevention is to be aware of the triggers that cause eczema flare-ups and to minimize your exposure to them.
- Identify AD – onset usually starts at a young age – see your pediatrician.
- Use moisturizers daily to keep the skin protected. Think of it as a preventative measure to minimize the chances of flaring.
- Common triggers include stress, low humidity, sweat, saliva (infants), hormonal fluctuations, and other general allergies like food, dander, or dust allergies. Minimizing exposure will go a long way in controlling AD flare-ups.
- Treat flares quickly and aggressively. Itching and inflammation lead to scratching, which leads to further itching.
- Watch for signs of infection if the skin is cracked and exposed.
There is also mounting clinical and genetic evidence supporting the idea of an atopic march – a progression into other atopic diseases.4 There may be a critical window to treat and manage atopic dermatitis effectively early in life, which can help prevent, slow down, or minimize the symptoms of other atopic diseases later in life.
Managing Flares and New Therapies” with Dr. Gooderham hosted by Eczema Society of Canada
Treatments
Topical Drugs: The most commonly prescribed drugs are topical corticosteroids. Calcineurin inhibitors may sometimes be prescribed instead. Both treatments aim to reduce inflammation and itch and are used to calm down flares.
Oral Drugs: Oral or systemic therapies are generally prescribed for more severe cases of atopic dermatitis. These drugs are typically prescribed for a short period – as they have more significant side-effects compared to topical medications.
Light Therapy: Light therapy or phototherapy is sometimes used in conjunction with topical therapy. Similar to oral treatment, it is used for short periods.
Antibiotics: Infection is a threat when the skin becomes exposed. Open sores or cracks are unfortunately common and leave it open to infection.
Recent Advances: Crisaborole (Eucrisa) and Dupilumab (Dupixent) have been approved by the FDA for treating atopic dermatitis in recent years and attack atopic dermatitis from a different angle, and have so far shown a lot of promise.5
Lifestyle
Atopic dermatitis is, unfortunately, a chronic condition that has no cure at this time. Many cases of atopic dermatitis wane or disappear as the patient grows older. However, patients will still need to learn to live with the condition for years.
Moisturize: Dry skin is a constant feature of atopic dermatitis, even when it is not flaring. Moisturize every day, preferably twice a day, to keep your skin hydrated. Moisturizers can be used in conjunction with other treatments.
Itch: Scratching is tempting – and let’s face it – sometimes irresistible. To the extent that we can, though, we should find alternatives to scratching – place ice on the itchy skin or press on the skin.
Sleep: Persistent itchiness can also have an impact on the quality of sleep.6 It can make falling asleep difficult and interrupt your sleep cycles. It’s also common to scratch without being aware of it. Wearing mittens at night can also help to minimize the damage that the skin takes.
Other: Many other factors play into a lifestyle – some are avoidable, while others can only be mitigated. Exposure to water, for example, often worsens atopic dermatitis (it drains moisture from the skin). Sometimes occupational responsibilities will expose you to water or other corrosive substances that aggravate your condition. It’s not always possible to manage all lifestyle factors, but being aware of triggers can help you plan and manage these factors better.
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1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576901/
2Many patients “outgrow it” or have milder symptoms as they get older. This isn’t always the case, however, and some adults will continue to suffer from symptoms of atopic dermatitis.
3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240310/
4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686261/
5http://www.dermatologytimes.com/dermatology/atopic-dermatitis-2018
6 https://nationaleczema.org/eczema-leads-to-problems-sleeping/
