Saint James School of Medicine Column: A Brief Introduction to a Common Skin Disorder: Atopic Dermat

By admin September 16, 2011 09:34

Saint James School of Medicine Column: A Brief Introduction to a Common Skin Disorder: Atopic Dermat

Atopic Dermatitis also known as Atopic Eczema or Infantile Eczema is an inflammatory, chronic, non-contagious and pruritic skin disorder. Affected persons react abnormally to irritants, food, and environmental allergens and their skin becomes red, flaky and very itchy. The skin of atopic patients is very vulnerable to surface infections caused by bacteria. The skin on the flexural surfaces of the joints (for example inner sides of elbows and knees) are the most commonly affected regions.
Atopic dermatitis most often begins in childhood before age 5 and may persist into adulthood. In some persons, it flares periodically and then subsides for a time, even up to several years. Yet, it is estimated that 75% of the cases of atopic dermatitis improve by the time children reach adolescence, whereas 25% continue to have difficulties with the condition through adulthood.
The first sign of atopic dermatitis is the red to brownish-gray colored patches that are usually very itchy. Itching may become more intense during the night. The skin may present small and raised bumps which may be crusting or oozing if scratched, which will also worsen the itch. The skin tends to be more sensitive and may thicken, crack or scale.

The cause of atopic dermatitis is not known, but the disease seems to result from a combination of hereditary and environmental factors. Evidence suggests that the disease is associated with other so-called atopic disorders such as hay fever (seasonal allergies) and asthma, which many people with atopic dermatitis also have. Emotional factors and stress may in some cases exacerbate or initiate the condition; they do not seem to be a primary or underlying cause for the disorder.

Since there is no cure for atopic eczema, treatment should mainly involve discovering the triggers of allergic reactions and learning to avoid them. Common trigger factors include:

• Exposure to allergens, such as pollen, animal dander , or molds.

• Exposure to irritants, such as using soaps, rubbing the skin and wearing wool.

• Exposure to workplace irritants, such as fumes and chemicals.

• Climate factors, especially winter weather and low humidity.

• Temperature changes. Sudden changes in temperature can result in increased itchiness. A suddenly higher temperature may bring on sweating which can cause itching.

• Emotional stress. Emotions such as frustration or embarrassment may lead to increased itchiness and scratching.

• Exposure to certain foods, typically eggs, peanuts, milk, soy or wheat products.

• Excessive washing. Repeated washing dries out the top layer of skin, leading to drier skin.

For severe cases, or cases that do not improve with prevention and maintenance, these treatments are recommended:
• A bandage or dressing that is wrapped around the affected skin, which covers any open sores and prevents contact with air.

• Exposure to ultraviolet (UV) light, with or without additional medicine. Options include phototherapy or psoralen plus ultraviolet light therapy (PUVA).

• High-strength topical corticosteroids or oral corticosteroids. These may be used when the rash covers large areas of the body or when complications, such as skin infections, occur.

• Cyclosporine or interferon, which is sometimes used in adults if other treatment is not successful.

-Maria Teresa Villagomez, MD, PhD, Professor of Epidemiology and Clinical Medicine

By admin September 16, 2011 09:34


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