What is Atopic Dermatitis how to treat it

Atopic dermatitis is genetically based skin disorder that is both chronic and relapsing. It is linked to a larger group of atopic diseases that includes asthma and hay fever. Approximately 40% to 50% of persons with atopic dermatitis develop manifestations of asthma or hay fever. Approximately 50% to 60% of patients with atopic dermatitis are from families with one or more atopic diseases. Exacerbating factors include sudden changes in temperature or humidity, exercise, psychologic stress, fibers such as wool, fur, or nylon, detergents and perfumes. Controlling environmental influences such as climatic changes and humidity levels can prove challenging for both patient and caregiver. 

Atopic dermatitis is most common in children. Up to 75% of children with atopic dermatitis develop symptoms by 6 months of age. It usually disappears or becomes less severe between the ages of 2 and 3 years but can recur in late childhood or adolescence. Resolution of symptoms is seen by age 30 in a large number of adults. 

The major symptoms of atopic dermatitis is intense pruritus chronic rubbing and scratching produces eczematous skin, followed by skin thickening and alteration in pigmentation (hypo pigmentation and hyperpigmentation). 

How do you get atopic dermatitis 

The protective barrier function of the skin is diminished greatly in the atopic population. Lipid content changes in the epidermis permit water loss from the cells, resulting in dry skin. Persons with atopic dermatitis are highly sensitive with a lowered threshold to pruritus. Even minor stimuli can produce intense episodes of itching. 

Atopic dermatitis results from an immunologic irregularity involving cytokines and other inflammatory mediators. There is a marked tendency toward vasoconstriction of superficial blood vessels, and the skin blanches readily. Cold and low humidity are poorly tolerated because of drying effects. Heat and high humidity are also poorly tolerated because vasodilation increases the inflammatory reaction, thus aggravating the dermatitis and causing increased itching and discomfort. The initial clinical presentation for atopic dermatitis is rough, dry skin that may appear as early as the first month of life. Infants may develop moist, oozing, crusting lesions on the scalp and face, with spread to the trunk and extensor aspects of the arms and legs. Later, the lesions become localized to the flexures of the neck, wrists, antecubital, and popliteal fossae, eyelids, and behind the ears. The erythema is dusky and excoriations may become secondarily infected. By late twenties or early thirties the lesions usually disappear, but they may recur later as chronic hand or foot eczema.

The compromised barrier function of the skin in atopic dermatitis places individuals at increased risk for acquiring viral, fungal and bacterial infections of the skin. 

Caring for atopic dermatitis suferrer

Atopic dermatitis has no cure, but symptoms can be controlled. Hydrating the skin is the cornerstone of therapy. Applying an occlusive moisturizing agent three or four times a day (preferably emollients in a water-in-oil base) works to reestablish a well-hydrated stratum corneum. Topical corticosteroid therapy is the principal pharmacologic agent used. Weaker potency corticosteroids are selected for the pediatric population. More potent topical corticosteroid should be reserved for adults, with education regarding method application, duration of use, and potential side effects. Topical corticosteroid may be used in concert with wet wraps, which can enhance drug absorption and help decrease pruritus. Systemic corticosteroid may be given for a limited period to selected individuals with severe atopic eczema.

Protopic ointment (tacrolimus) and pimecrolimus (Elidel) cream are two topical immunemodulators specifically developed for treatment of moderate to severe atopic dermatitis. They are highly selective agents that block T-cell activation, thus targeting immunologic overactivity and halting the inflammatory cascade. Itching, burning, and irritation may occur within few days of start of treatment, but they proven safe for use, even though both child and adult patients should avoid natural and artificial sunlight for long periods. 

Systemic therapy with sedating antihistamines at night (when itching is more intense) can be helpful. Treatment of secondary bacterial skin infections with appropriate antibiotics may be warranted. In some instances patients may benefit from phototherapy with Ultraviolet B (UVB) or Ultraviolet A (UVA) plus psoralen (PUVA).

Patient/Family Teaching 

Successful management of atopic dermatitis is achieved through patient, family and health care provider collaboration. Provision of comprehensive written skin care instructions and demonstration of techniques for application of topical drugs are critical nursing measures.  Addressing social and emotional concerns of patients with atopic dermatitis is another challenging area for intervention. Chronic manifestation of this skin disease can set the stage for social isolation, poor self-esteem, anxiety and sleep disturbance. 

Teaching should include information about the disease, prescribed medications, and the following instructions:

1. Use only gentle cleanser and soaplike products.
2. Take a relaxing, warm bath for 15 to 20 minutes; gently pat away excess water and immediately apply a moisturizer. Reapply moisturizers throughout the day when skin is dry.
3. Use wet wraps in place of tub soaking if desired; wraps permit evaporation which cool the skin, thus decreasing pruritus. 
4. Apply topical medication in a thin layer and rub in well.
5. Avoid wool, fur, or rough fibers against the skin; they act as irritants and cause itching.
6. Avoid overheating, which increases sweating, leading to itching. Wear loose, light clothing in hot weather. Air conditioning promotes comfort.
7. Avoid sunburn; wear a sunscreen with a minimum sun protection factor of 15.
8. Avoid excessive cold, which dries the skin.
9. Wash all new garments before wearing to remove potentially irritating chemicals.
10. Consult health care  professional if eczema worsens.