Understanding Atopic Dermatitis

Atopic dermatitis, which is also known as eczema, is an itchy, persistent skin rash. It usually starts as dry, itchy skin. The rash may become very red and sore. It usually involves the knee folds and the elbow creases, but may involve other body parts as well. Babies and children are more likely to have the rash on their cheeks.

In India, it is more common in urban areas than rural. In some individuals, it may persist in adulthood.You are more likely to have atopic dermatitis if a family member has it but you cannot catch it from other people.

What causes atopic dermatitis?

The causes of atopic dermatitis are not known. However, it is thought that genetic susceptibility, immune differences and skin susceptibility contribute to it.It is often associated with asthma and allergic rhinitis (hay fever).

Diet, chemicals applied to the skin (e.g. soap, washing powder, perfume) and airborne allergy-triggers can cause outbreaks of atopic dermatitis. Airborne allergy-triggers can include such things as pollen, mould spores, dust mites and animal hair.

Typical appearance of atopic dermatitis

Atopic dermatitis usually appears as dry, cracked skin which is very itchy. Sometimes these areas of skin become blistered and weepy and get infected. A typical pattern if for the inflamed areas of skin to ‘flare-up’ from time to time, and then to settle down again. The severity and duration of ‘flare-ups’ varies from person to person, and from time to time in the same person.

In mild cases, a flare up may cause just one or two small, mild patches of inflammation. In severe cases, the flare-ups can last several weeks or more, and cover several areas of skin.

Can atopic dermatitis be cured?

There is no “cure” for atopic dermatitis in the usual sense. There are several medicines and preparations that will help control outbreaks and provide relief of symptoms, but there is no single effective treatment. Your doctor will be able to discuss the various options with you.

How can atopic dermatitis be controlled?

Atopic dermatitis can be controlled with the help of:

  • Emollients (moisturisers) – emollients can prevent and soothe dry skin and irritated skin
  • Topical steroids (steroid creams and ointments) – these are mainly used to control inflammation when the dermatitis flares up

Preventing flare-ups with good skin care is an important part of the overall treatment of atopic dermatitis.

Emollients are lotions, creams, ointments and bath/shower preparations that prevent the skin from becoming dry. They ‘oil’ the skin, keeping it flexible and moist. Regular use of emollients is the most important part of the treatment for atopic dermatitis.

They should be applied as often as they are needed. This may be twice a day or more frequently if your skin becomes very dry. Usually, thicker, greasy ointments work better and are effective for longer than thinner creams, but they are messier to use. It is not possible to “overdose” on emollients, so always use plenty.

A common mistake is to stop using emollients when the skin appears good. Patches of inflammation may then quickly flare-up again.

Topical corticosteroids are steroid preparations applied directly onto the skin. They are used when atopic dermatitis flares up and work by reducing inflammation.

It is important that you continue to use emollients therapy during treatment with topical corticosteroids.

Infection: Sometimes, one or more patches of skin affected by atopic dermatitis may get infected during a flare-up. If your skin shows signs of crusting and weeping and normal-looking skin becomes red and inflamed, or if your atopic dermatitis suddenly becomes much worse, see your dermatologist as soon as possible.

What care can be taken?

Atopic dermatitis is a chronic condition and good skin care is the key to keeping it under control. The regular and consistent use of emollients is very important, and it is important to keep using them even when there is no obvious ‘flare’.

  • When bathing, use mild soaps, or none at all. Don’t stay in the bath or shower too long; use warm (not hot) water. Put on an emollient immediately afterwards, while your skin is still damp.
  • Avoid wearing clothes made of scratchy materials like wool. Wear cotton clothes next to your skin whenever possible. Some smooth man-made fabrics are probably just as good as cotton.
  • Although food allergy is rarely a cause of atopic dermatitis, certain foods might make your rash worse. If you notice that happening, you may want to avoid those foods.
  • Try as much as possible not to scratch the dermatitis. To help with this, keep nails short and use anti-scratch mittens in babies.
  • Avoid extremes of temperature as these can irritate the skin.
  • If you have had a skin infection, once it is cleared, it is advisable to throw away your usual creams, ointments and lotions and get new supplies. This is to reduce the risk of using treatments which may be contaminated with bacteria.

Written by -

Dr.Kislay Saurav Jha

Dermatologist (Visiting Specialist)


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