Atopic Dermatitis

 Dr K S Prasanna, Dermatologist, Institute of Applied Dermatology, Kasaragod, Kerala

3 years old intensely crying Eshan was accompanied by his disheartened parents to our institute (IAD) to consult Dr. SRN. They had come from Bangalore. He was very irritable, crying and shouting, reluctant to enter the doctor`s room. He wasn’t fond of doctors, especially since they never seemed to be able to help him. Our dermatology nurse, who is very balanced, mature, and extremely well equipped to counsel the patients, helped the parents and brought the child to the doctor`s room. The nurse collected all their previous case records, organized them in a file in date wise manner, and presented the case to the doctor. The doctor examined the patient in great difficulty because the child was not cooperative at all. Being very irritable, Eshan didn’t allow the doctor to examine him, and the doctor had to overcome this hurdle. The child was fed up with going to doctors. DR SR N took the history in detail and diagnosed the condition as Atopic dermatitis (severe form). He spent his quality time with the parents, explained each detail of the disease and how to manage the disease including the diet. The dietician and nurse counselor also spent time with the parents and educated them. The day was done by the time they left the institute. They went back with a ray of hope on their face.

They came for follow-up every month. On their fourth visit, Eshan was not crying. He came with his mind at ease, and was comfortable, stood near DR SR N `S chair, looking at his face, probably yearning to express his gratitude to the one who realized the depth of his problem. This hospital visit went on for one year. By this time, both Eshan and his parents learned to manage the disease. But after some time, again during winter, the disease got worse, but this time Eshan himself told his parents to visit the IAD doctor only, and no one else. He came with a packet of chocolate for his doctor and the loving team IAD.

 It is the story of thousands of Eshan`s. It is a chronic, relapsing condition called Atopic Dermatitis. It is a frustrating condition both for the child and for parents, if not managed properly. Treating severe Atopic dermatitis is a challenge for a doctor. The only empathetic doctor can succeed to gain the confidence of atopic children like Eshan.

It is the most common chronic inflammatory skin condition. It affects 20-30% of children and 3-10% of adults. It has complex pathogenesis, which includes skin barrier dysfunction and immune deregulation that is driven by interaction with genetic and environmental factors. The strongest risk factor for Atopic dermatitis is a family history of atopic disease. Atopic march is well known and represents the natural progression of atopic disease in patients with the development of atopic dermatitis followed by other atopic conditions such as Asthma and allergic rhinitis. Environmental factors are also important determinants of the disease. The risk factors are living in an urban setting and a region with low ultraviolet exposure or dry climatic conditions. Another risk factor is certain foods that increase the disease. The atopic children should avoid peanut, hen`s egg, cow's milk, sesame seed, a diet high in sugar, and poly saturated fatty acid.

 

It is characterized by intense itching. It is divided into infantile, childhood, and adult stage. In each stage, patients develop eczematous lesions which are intensely itchy. There may be oozing and crusting. Later on, in adults, the skin becomes thickened and dark. Later on, there may be only involvement of flexures like the elbow and behind the knee. Sometimes in severe form, there may be generalized peeling of skin with redness. Characteristics features of Atopic dermatitis include pruritus and or chronic relapsing course, usually beginning during infancy (early onset) but occasionally developing in adulthood (late-onset).

 Treatment of atopic dermatitis is a complex process and is time-consuming to both the doctor and patients. It includes topical, orals, and the advice of proper dietary protocol. Bathing is an important step in management because it hydrates the skin and removes the scaling and crusting. Should bathe for 5-10 minutes in warm (not hot) water with the use of fragrance-free non-soap cleansers with a neutral to low ph. (e.g., syndets). Application of moisturizer shortly after bathing is essential to maintain skin hydration. If topical corticosteroid or other anti-inflammatory agent is needed, it should be applied immediately after bathing, before the application of moisturizer. In addition to this oral antihistamine should be given.

 

 There is no cure for atopic dermatitis, but many children find their symptoms improve naturally, as they grow older. They learn to live with the disease.