Atopic Dermatitis

Atopic dermatitis is the most common type of eczema (atopic dermatitis eczema). Atopic dermatitis is a chronic condition that causes your skin to become red and itchy for a period of time after which it can go away and reappear at any time in life.

Before we dive into the subject of atopic dermatitis in particular, let’s have a look over what dermatitis is and the multiple ways it can be classified in.

Dermatitis

Dermatitis is a medical term used to describe a group of conditions that affect the skin, making it dry, red and itchy. Dermatitis is usually caused by allergies, infections, different substances or even genetics and its symptoms can go from mild to severe. Further, we’ll discuss some of the (many) types of dermatitis that can affect your skin, other than atopic dermatitis which will be discussed in detail later on.

Contact dermatitis. This type of dermatitis is triggered by direct contact with a substance that irritates the skin or causes an allergic reaction of the skin. Because of this, there are two sub-types of contact dermatitis: irritant contact dermatitis, in which case the rash is a nonallergic reaction to a substance that disrupts the skin’s protective layer and allergic contact dermatitis which happens when the substance that comes in contact with the skin causes an allergic reaction (it’s called an allergen).

Seborrheic dermatitis. This is a type of dermatitis that in addition to making the skin red and itchy, it also causes the formation of some flaky scales. It is also known as dandruff or cradle cap and it can look similar to psoriasis or atopic dermatitis. It’s most common in babies, but it can also appear during puberty or adulthood. The body parts that are typically affected are the scalp, eyebrows, nose and behind the ears, but it can also appear anywhere there is hair or skin folds.

Diaper dermatitis. Diaper dermatitis is a very common rash in babies or toddlers that in most cases is caused by the baby’s skin contact with different substances (which makes it a type of contact dermatitis) in the diaper area. However, some other causes can be yeast infection (candida), seborrhea, bacteria or allergies. Because of the location of the area affected, urine and feces contribute to the rash so a proper hygiene routine is essential in managing this condition.

Neurodermatitis. Neurodermatitis is a type of dermatitis in which the affected skin can become leathery or scaly as a result of intense scratching. The cause is not exactly known, but the persistent need to scratch and rub the area can be triggered by something that irritates the skin. Characteristic for this type of dermatitis is the intensity of the itchiness which can become unbearable and can affect the person’s day to day activities.

Nummular dermatitis. Or discoid eczema, is a type of dermatitis that manifests through coin-shaped spots on the skin that are itchy, red, might have liquid or crust and give a burning sensation. You can get it at any age, this type of eczema being triggered by dry or sensitive skin, lesions of the skin, insect bites, burns or other types of dermatitis (e.g. contact dermatitis).

Dyshidrotic dermatitis. It’s also called foot and hand dermatitis or palmoplantar dermatitis because it only appears on the hands and feet. Characteristic for this type of dermatitis are the blisters that can be extremely painful or itchy, flaring up in the palm of the hands, soles or between the fingers and toes. Nickel, stress, seasonal allergies or sweaty palms are the most common triggers for this type of eczema.

Stasis dermatitis. Stasis dermatitis is also known as gravitational dermatitis or venous dermatitis and is caused by poor circulation or venous insufficiency in the lower limbs. Because of this, this type of dermatitis usually affects people over fifty, with women being more at risk to get it. The most common symptoms include ankle swelling, spots of discoloration on the skin, itchiness, dryness and a heavy feeling in the legs after standing or sitting up for too long.

Periorificial dermatitis. As the name suggests, this type of dermatitis is characterized by multiple small, itchy, red papules that cluster together around different orifices of the body, such as the eyes, mouth, nose, rarely genitals. While the specific cause of this dermatitis is not known, some triggers can be steroids applied topical, inhalers, cosmetics, toothpaste or poor hygiene of the skin.

Now that we’ve covered the most common types of dermatitis, let’s move onto the subject of atopic dermatitis, the most prevalent of them all.

Atopic Dermatitis

Atopic dermatitis is a chronic condition that appears and disappears over periods of time and is characterized by red, itchy rashes on the skin. The term “atopy” refers to an allergic predisposition of the skin that can be associated with other medical conditions such as asthma or allergic rhinitis.

People with atopic dermatitis have a very sensitive skin, prone to infections and dryness. What medical professionals have discovered so far about this condition is that patients with atopic dermatitis have an overactive and “messy” immune system that makes it very easy for inflammation to occur, damaging the skin barrier and causing rashes.

Symptoms of Atopic Dermatitis

Atopic dermatitis has a set of symptoms and signs that make it fairly easy to recognize, but these can vary from one person to another and even in the same person, from one flare up to another. Because it’s a chronic condition, atopic dermatitis can manifest periodically or between long periods of time. It usually appears at small ages, before the age of five, and can go well into puberty and adulthood.

The most common symptoms and signs are:

brown-red patches of skin;
dry skin;
small bumps that can leak fluid or even bleed when scratched;
cracked, crusted or scaly skin;
itchiness which in some cases can be severe, the worst intensity manifesting at night time;
itch-scratch cycle – the intense itchiness leads to intense scratching, which in turn worsens the itchiness (contrary to the belief that if you scratch the spot, the itchiness will go away);
raw and swollen skin from intense scratching that later can cause the affected area of skin to thicken and harden (lichenification);
some of the most common areas affected can be the lower and upper limbs, the upper chest, the folds of skin (e.g. inside the elbows or knees), the face, but it can appear virtually anywhere on the body.

What’s characteristic for this condition is that it has two stages: exacerbations (flares) and remissions. The exacerbations are the periods of time when the symptoms get worse and really intense and the remissions are the times when the affected skin areas clear up and don’t cause any more discomfort (until the next flare).

Triggers for Atopic Dermatitis

There are some factors that can trigger the symptoms for people who have atopic dermatitis such a low humidity and temperature levels which is not beneficial for the dry skin, allergies (especially seasonal allergies such as hay fever) or use of different skin care or cosmetic products that contain substances that the skin doesn’t respond well to.

Causes for Atopic Dermatitis

Causes for atopic dermatitis

As far as what causes it, professionals have yet to solve the mystery. However, research has provided some insight into the fact that people with atopic dermatitis have a specific mutation of a gene that is responsible for the production of filaggrin, a protein involved in creating a good protective barrier for the skin. If the body doesn’t have much protein to maintain this barrier, it leaves the skin vulnerable to bacteria, viruses or other agents that can compromise the integrity of the skin and lead to inflammation and/or infection.

Plus, as we’ve highlighted before, it appears that people who suffer from this chronic, long-lasting condition also exhibit an erratic immune system that contributes to the low-functioning or ineffective protective barrier of the skin.

Risk factors for Atopic Dermatitis

Who is more likely to get atopic dermatitis? Atopic dermatitis is a very common condition, affecting females and males equally. It usually starts in the first six months of life, but it can also develop later into childhood. It typically flares up periodically during the first years of life; for some people it can go away by the time they reach adolescent years, while for others it never really goes away, suffering from this condition well into adulthood. It’s very rare for someone to get atopic dermatitis for the first time later in life, but if it happens, it’s usually caused by exposure of the skin to damaging factors.

The most important risk factor for getting atopic dermatitis appears to be genetics, meaning that if you have a family history of any type of dermatitis (eczema), you are more likely to get it as well. What’s more, atopic dermatitis doesn’t always come alone and some people experience it because of two other medical conditions – asthma or allergic rhinitis (hay fever).

Is Atopic Dermatitis Contagious?

The short answer is that no, atopic dermatitis is not contagious, meaning that it cannot be transmitted through skin contact. However, someone who has atopic dermatitis with secondary infections such as infections with bacteria, staph, herpes or fungi may be contagious.

Complications of Atopic Dermatitis

Given that people with atopic dermatitis have an unstable immune system, this means that sometimes it can become weak, leaving the person vulnerable to other medical conditions, such as fungal foot disease or infection with staph or bacteria.

Some other complications of this chronic medical condition can be asthma and/or hay fever, with more than half of children with atopic dermatitis developing asthma or hay fever; chronic itchy skin; skin infections – lesions of the skin caused by intense scratching can leave the skin open and vulnerable to bacteria and viruses; sleep difficulties because of the itch-scratch cycle that can disrupt the sleeping patterns. Plus, people with atopic dermatitis can also develop other types of dermatitis, such as neurodermatitis, irritant hand dermatitis or allergic contact dermatitis.

Where on your body can you get Atopic Dermatitis?

Atopic dermatitis can flare up almost anywhere on your body, but there are some more commonly affected areas among people. These are:

the face, eyelids, eye (atopic dermatitis on face, atopic dermatitis eyelid, atopic dermatitis eye);
the scalp (atopic dermatitis on scalp);
the neck (atopic dermatitis on neck);
the breasts (atopic dermatitis on breast);
the hands and legs (atopic dermatitis on hands and legs).

Atopic dermatitis on face. An interesting case of atopic dermatitis is atopic dermatitis on face which can be quite damaging to the skin, causing serious alterations. Atopic dermatitis on the face is usually more common in babies and toddlers because of their drooling that can irritate the skin from the excessive amount of saliva. However, it can also affect people of different ages especially because the skin in the face area is particularly sensitive and delicate (with the skin around the eyes being the thinnest). When we talk about atopic dermatitis on the face we mean that it can affect also the eyebrows, lashes, eyelids (atopic dermatitis eyelid) and skin around the eyes (atopic dermatitis eye). What makes this a more serious condition is the fact that the itchiness leads to scratching which in this case can cause the area of skin around the eyes to change in appearance. The change can be so dramatic that some people develop an actual extra fold of skin under the eyes, which is known as an atopic pleat. Other people might experience different changes in appearance, such as hyperpigmented eyelids (the skin of the eyelids darkens due to the inflammation caused by atopic dermatitis) or patchy eyebrows and eyelashes (due to intense scratching).

Atopic dermatitis on breast. Another area on the body where atopic dermatitis is quite common is the breasts. Itchy breasts or nipples are typically caused by atopic dermatitis. There are some specific factors that can aggravate the symptoms, such as dry skin, artificial fibers and fabrics, perfumes or cosmetic products. However, there are also other potential causes for itchiness in the breast area, such as pregnancy (the breasts enlarge causing the skin to stretch), mastitis (infection of the breast tissue) or even breast cancer.

Atopic dermatitis on scalp. It is quite rare for atopic dermatitis to develop on the scalp, this area being more prone to seborrheic dermatitis. However, especially in small children, atopic dermatitis may appear on the scalp, the difference between this one and the seborrheic one being that in atopic dermatitis the bumps of the affected area can have an oozy liquid.

What does your skin look like if you have atopic dermatitis?

Atopic dermatitis causes some particular skin features that make it easier to diagnose it and differentiate between atopic and other types of eczema. These characteristic skin features include:

lichenification and lichen simplex – thickened spots of skin caused by rubbing and constant scratching;
papules or vesicles – skin bumps that can contain liquid; they can open if scratched, leaving the skin vulnerable for infection;
ichthyosis – fish-like scales on the skin;
hives – or urticaria, is an allergic reaction which follows contact with an allergen;
inflammation of the skin, especially around the lips;
atopic pleat (extra skin under the eyes), hyperpigmented eyelids and dark circles.

Atopic dermatitis toddler / Atopic dermatitis infant

atopic dermatitis infant

We’ve seen so far that the most at risk for developing atopic dermatitis are babies and children, this condition typically debuting in the first six months of life. While the exact cause for this chronic, long-term medical condition is unknown, a combination of genetics and environmental factors might be the answer. However, not all babies are at risk for developing atopic dermatitis, the most common risk factor being a family history of dermatitis and allergies. In children, the most affected areas of skin are the scalp, face, elbows and knees, as well as the skin around the mouth or in the diaper area.

How is Atopic dermatitis diagnosed?

Being a skin condition that is also most commonly prevalent in children, the healthcare professionals that can help diagnose and treat atopic dermatitis are pediatricians, dermatologists and allergists. The diagnosis can be made following a physical exam and visual inspection of the area of skin affected. Plus, family and patient health history can help in making the diagnosis. There isn’t a miracle test that can diagnose atopic dermatitis, but blood tests and skin tests may be recommended by doctors to assess the levels of immunoglobulin and whether there are some allergies present that could interfere with the skin condition. To sum it up, if you or your child go to a healthcare professional looking for a diagnosis of atopic dermatitis, there are a few steps they might take:

ask about the symptoms and health history of the patient;
ask about family history of relevant medical conditions (e.g. dermatitis, asthma, allergies);
ask about any allergic reactions of the patient;
conduct a physical examination of the patient;
recommend further testing if necessary (blood tests or skin and allergy tests).

How to treat atopic dermatitis?

Unfortunately, there is no known cure for atopic dermatitis. However, skin specialists have narrowed down a few pharmacological and non-pharmacological remedies that can help manage the symptoms and even reduce the intensity and time-frame of a flare-up. The treatment for atopic dermatitis depends very much on the severity of the symptoms, and considering how bad they are, your doctor might recommend medication. In most cases, though, a good skin care regimen and adequate lifestyle choices can be enough to tame down an exacerbation of atopic dermatitis.

Atopic dermatitis how to treat:

Non-pharmacological treatment options include:

using appropriate skin care products – limiting cleaning and cosmetic products to just one soap and one moisturizer that is dermatologically tested and recommended for sensitive skin; this usually implies staying away from any lotions, fragrances or products with chemical substances that could exacerbate the symptoms;
having consistency in your skin routine – maintaining a constant regimen for the skin is essential in preventing any type of infection, but also in keeping the skin moisturized at all times;
avoiding any triggers – identifying and removing any potential triggers that might cause a flare-up;
avoiding synthetic or wool clothes – these are irritants for the skin;
using a humidifier – maintaining a constant level of humidity in the environment is useful for the affected skin.

Pharmacological treatment options include:

corticosteroids – usually prescribed as a cream or ointment that is applied locally; they help easing the intense itchiness as well as reducing the swelling; usually recommended in mild dermatitis;
calcineurin inhibitor – just as corticosteroids, this inhibitor is applied directly on the skin, as a cream or ointment, aiming to reduce itchiness and swelling; this is usually recommended if the first one doesn’t work and dermatitis becomes moderate to severe;
phototherapy – in case of severe dermatitis;
antibiotics – when atopic dermatitis causes the skin to break and get infected, sometimes the patient might need antibiotics to treat the infection;
antihistamine medicine – helps with the itchiness; also used in allergic reactions.

Atopic dermatitis – prevention

We’ve seen that the exact cause of atopic dermatitis is not known so there are no ways to prevent it from developing. However, there are some actions you can take in order to prevent the flare-ups from reappearing, such as: moisturizing religiously, identifying and avoiding potential triggers, taking shorter baths and using soaps and creams designed for sensitive skin.

Conclusion

Atopic dermatitis is a chronic skin condition that is very common nowadays. While we don’t know yet what exactly is the cause of this eczema, genetics and environment seem to play the main roles in the development of atopic dermatitis in the early stages of life. The symptoms of this condition can have a huge impact on a person’s life, ranging from sleep disturbances caused by extreme itchiness to body image issues if it occurs later in life. Even though this is a long-lasting condition that can have periods of remission, there are a number of treatment and preventative solutions that can help ease the symptoms, reducing the impact this condition has on one’s quality of life.