Atopic Dermatitis (AD)/Eczema
Chronic dermatitis or eczema pruritic condition. Frequently associated with allergies, hay fever, sinusitis or asthma – IgE levels are high (95% of those with atopic dermatitis have asthma). Strong hereditary/family influence. Involves some disturbance to immune system (in those genetically predisposed) - especially imbalance of cytokines. Usually have high serum levels of IgE antibodies (indicates an abnormal response to a trigger) and abnormal lipid concentration in the skin. Occurs in up to 5-10% of infants – most have remission by age 15. Incidence is assumed to be increasing.
Characterised variably by patches of pruritis, moist erythematous weeping skin in acute stage and dryness, scaling, and lichenification in the chronic stage. Begins on face – later involves flexor surfaces of the extremities – often improves by ages 3 to 4. In adulthood, may reappear on hands and feet. Itch cycle can induce lichenification.
Skin can be dry. Can also get hyperlinear palm and sole creases that worsen with lubrication.
Trigger factors – house dust mite (most common), foods (eg peanuts, eggs, milk, wheat), contact allergens
Treatment – parental education; avoidance of itching; treat inflammation (topical steroids are first line drug for flare up); dry skin care (brief bathing; hydration with bland emollients); control exacerbating factors; reduce exposure to antigens; immunomodulatory drugs if severe (eg cyclosporine).