Diseases Atopic Dermatitis

Atopic Dermatitis

Atopic dermatitis (a type of eczema) is an inflammatory, chronically relapsing, non–contagious and pruritic skin disorder

  • Genetics8,9 : A family history of atopic dermatitis is common. Genome–wide scans have highlighted several atopic dermatitis–related loci on 3q21, 1q21, 16q, 17q25, 20p, and 3p26. Several candidate genes have been identified (5q31–33); they all encode cytokines involved in the regulation of IgE synthesis.
  • Infection: The skin of patients with atopic dermatitis is colonized by S aureus. Clinical infection with S aureus often causes a flare of atopic dermatitis, and S aureus has been proposed as a cause of atopic dermatitis by acting as a superantigen.
  • Hygiene: The hygiene hypothesis is touted as a cause for the increase in atopic dermatitis. This attributes the rise in atopic dermatitis to reduced exposure to various childhood infections and bacterial endotoxins.10,11
  • Climate: Atopic dermatitis flares occur in extremes of climate. Heat is poorly tolerated, as is extreme cold. A dry atmosphere increases xerosis. Sun exposure improves lesions, but sweating increases pruritus. These external factors act as irritants or allergens, ultimately setting up an inflammatory cascade.
  • Food antigens: The role of food antigens in the pathogenesis of atopic dermatitis is controversial, both in the prevention of atopic dermatitis and by the withdrawal of foods in persons with established atopic dermatitis. Most reported studies have methodologic flaws. Because of the controversy regarding the role of food in atopic dermatitis, most physicians do not withdraw food from the diet. Nevertheless, acute food reactions (urticaria and anaphylaxis) are commonly encountered in children with atopic dermatitis.
  • Probiotics12 : The role of probiotics in the diet of patients with atopic dermatitis remains controversial
  • Aeroallergens: A role for aeroallergens and house dust mites has been proposed, but this awaits further corroboration.
Risk Factors
The following appear to increase one’s risk :
  • Family history. A family history of atopic (tendency for excess inflammation in the skin, linings of the nose, and lungs) conditions, such as atopic dermatitis, asthma, or hay fever. This remains the strongest risk factor. If one or both parents have a history of atopic dermatitis or an allergic condition, the child is much more likely to develop atopic dermatitis.
  • Where person lives. Living in a developed country, urban area (especially one with higher levels of pollution), or northerly part of the world seems to increase the risk. For example, Jamaican children living in London are twice as likely to develop atopic dermatitis as are Jamaican children living in Jamaica.
  • Age. Appears before 1 year of age in 65% of people; 90% develop before reaching 5 years of age.
  • Gender. Females are slightly more likely than males to develop.
  • Mother’s age at time child born. Atopic dermatitis tends to be more common when the mother gives birth to a child later in her childbearing years.
  • Year born. During the last 40 years, a steadily increasing number of people worldwide, mostly children, have developed atopic dermatitis. In the United States alone, the prevalence of atopic dermatitis in children born after 1980 has increased by 15% to 20%. This equals a 3– to 4–fold increase over the 5% prevalence rate reported during the 1950s in school–age children.
  • Social class. Atopic dermatitis tends to be more common in higher social classes.
  • Family size. Atopic dermatitis tends to be more common in immediate families that are smaller in size.
Factors aggravating Dermatitis :
Dust and sand.
Soaps and washing powders.
Regular washing.
Stress and emotional upsets.
Usage of Skin drying cosmetics.
Extreme weather like coldness.
Scratching and Itching.
Using rough clothes or woollen dresses.

Signs & Symptoms

Major Features
  • Intense itching
  • Characteristic rash in locations typical of the disease
  • Chronic or repeatedly occurring symptoms
  • Personal or family history of atopic disorders (eczema, hay fever, asthma).
Some Minor Features
  • Early age of onset
  • Dry skin that may also have patchy scales or rough bumps
  • High levels of immunoglobulin E (IgE), an antibody, in the blood
  • Numerous skin creases on the palms
  • Hand or foot involvement
  • Inflammation around the lips
  • Nipple eczema
  • Susceptibility to skin infection
  • Positive allergy skin tests.

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