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Atopic dermatitis (AD) is a disease in which you can only reduce symptoms with the right medications and care. The main symptom of atopic dermatitis is itching. The itching can be so bothersome that the person cannot sleep and function normally. Atopic dermatitis is mainly associated with children, but adults also suffer. The atopy associated with AD is an innate tendency to allergic reactions to various antigens. In the case of AD, these reactions are related to the skin.

Atopic dermatitis - what is this disease?

Atopic dermatitis-AZS(Latindermatitis atopica ) is a chronic inflammatory disease skin. Atopic dermatitis in children and atopic dermatitis in adults have similar symptoms - the most characteristic being persistent itching, which significantly worsens the quality of life of patients.

In the course ofatopic dermatitis , the symptoms of the disease often fade and worsen again. It is now believed that the development of atopic dermatitis is related to a combination of genetic, environmental and immunological factors.

Atopic dermatitis - causes of AD

The causes of atopic dermatitisare not fully understood.

  • It is known thatatopic dermatitisis associated with skin disorders. Their essence is the loss of the protective function of the epidermis. The structure of the epidermis is changed: the connections between its cells are loosened and the outer layer of lipids is lost (the so-called skin lipid coat). These changes prevent the epidermis from functioning as a barrier. Water evaporates more easily from the surface of the body, which makes the skin dry. From the outside, the penetration of infectious agents, pollutants and foreign substances is facilitated. The skin becomes oversensitive and irritated. There is also a characteristic itching.
  • When it comes to the genetic factors of AD , a special role is assigned to genes encoding filaggrin, i.e. one of the proteins that build the epidermal barrier. A genetic disorder in the structure of this protein is the cause of some casesatopic dermatitis. The disease developing on this basis is usually more severe and responds worse to treatment.
  • On the other hand,atopic dermatitisis associated with the shift of the immune system towards allergic reactions and the production of large amounts of inflammatory agents. It is not known, however, in which direction the cause-effect sequence takes place. Perhaps it is the damaged epidermis that is the site of penetration of foreign substances and allergens, which then contribute to the dysregulation of the immune system.
  • Another hypothesis is that there is a tendency towards allergic and inflammatory reactions that lead to damage to the skin barrier.
  • There are environmental factors that may contribute to the development ofatopic dermatitis . As in the case of other allergic diseases, one of the popular theories about the causes of AD development is the so-called "excessive hygiene hypothesis". According to this hypothesis, limiting a child's exposure to various substances in early childhood (by being brought up in "sterile" conditions) prevents the proper development of the immune system and causes a variety of hypersensitivity reactions later in life.
  • It is also worth mentioning the important role of psychological factors that may contribute to the exacerbations of the disease process. The severity of AD symptoms often occurs when patients experience strong emotions or stressful situations.

Atopic Dermatitis - Symptoms

The firstsymptoms of atopic dermatitisusually appear in childhood. Depending on the source, it is believed that only 5-15% of patients suffer from the disease beginning after the age of 5.

Common symptoms of atopic dermatitis:

  • erythematous, papular and often exudative skin lesions
  • skin is dry, tends to crack and discolor
  • a characteristic symptom is bothersome itching, causing constant scratching (especially at night when the patient is unable to control)
  • scratching causes further irritation - this creates a vicious cycle, causing constant deterioration of the skin
  • a characteristic symptom is the so-calledskin lichenification . The surface of the skin looks as if we were looking at it enlarged - all irregularities become visible to the naked eye
  • The second phenomenon typical of AD is white dermographism. It consists in the formation of white marks on the skin caused by scratching it
  • the chronic form of atopic dermatitis leads tothickening of the skin.

Atopic dermatitistends to occupy the so-called the flexion surfaces of the limbs, that is, the elbows and poplite pits. Other characteristic places are the torso and hands. These skin lesions are typical of adults and older children. In babies, the first changes usually appear on the face.

Atopic dermatitis - what exacerbates symptoms?

Skin eruptions can be aggravated by a variety of factors, such as:

  • changes in ambient temperature
  • certain types of cosmetics and materials (especially wool)
  • inhalation and food allergens

The courseof atopic dermatitisusually consists of consecutive periods of exacerbation and remission (decay). The disease also carries the risk of complications, such as superinfection of skin lesions by infectious agents. Children diagnosed with AD are at increased risk of developing other allergic conditions (e.g., bronchial asthma and allergic rhinitis).

It is also worth remembering thatatopic dermatitissignificantly affects the quality of life of patients; a particularly troublesome phenomenon is the constant itching of the skin. This symptom can also cause sleep disorders.

Atopic Dermatitis - Treatment

Treating atopic dermatitisis a long and complex process. Both pharmacological and non-pharmacological methods are available. The most important ones include:

  • atopic dermatitis - non-pharmacological treatment

The basis of the treatment of atopic dermatitis is care with the use of special agents called emollients. These are preparations based on fats, whose task is to rebuild the skin's lipid layer and "repair" the epidermal barrier. Regular use of emollients retains water in the deeper layers of the skin and prevents it from drying out.

In the care of atopic skin, avoid cosmetics containing irritating substances, fragrances and preservatives. In the case of concomitant food allergies, it is necessary to follow an appropriate elimination diet. Long and hot baths are also not recommended. It is worth observing your body and avoiding factors that cause exacerbation of skin changes (woolen clothes, inhalation allergens, stress).

Phototherapy is a very important method of AD treatment. This is treatment with ultraviolet radiation. It consists in irradiating the surface of the skin affected by the processa specially selected light beam. Phototherapy helps to relieve itching and inflammatory reactions. However, this method is not used in children under the age of 12.

  • atopic dermatitis - local pharmacological treatment

For many years, the basis of pharmacological treatmentADwere topical glucocorticosteroids (commonly referred to as steroids). They mainly have an anti-inflammatory effect. This group of drugs includes many preparations of different strength and duration of action, which enables individual therapy.

Ointments based on glucocorticosteroids are effective in the treatment of exacerbations of skin lesions. Unfortunately, they are not suitable for chronic use - in long-term therapy they carry a risk of side effects (thinning and atrophy of the skin, stretch marks).

The second group of topical medications used in the treatment of AD are the so-called calcineurin inhibitors. This group includes two preparations: tacrolimus and pimecrolimus. The main advantage is the lack of side effects typical of steroid therapy. The main disadvantage is their high price so far.

The use of local disinfectants, especially antibiotics, remains an important issue. Their use is recommended only in the event of infection (superinfection) of skin lesions. Do not use antibiotic ointments "just in case". Such a procedure favors the development of bacterial resistance to antibiotics.

  • atopic dermatitis - general pharmacological treatment

No satisfactory response to local therapyADmay be an indication for the use of systemic drugs. These are measures to inhibit inflammatory reactions. Oral glucocorticoids are the first line of therapy.

As with topical preparations, their chronic use should be avoided. Another group of systemic drugs are the so-called immunosuppressants, inhibiting the excessive activity of the immune system. Representatives of this group are e.g. methotrexate and cyclosporine. They are used onlyin severe forms of AZS .

Antihistamines are used to assist in the treatment of atopic dermatitis, which primarily help to control troublesome itching.

Atopic dermatitis - care rules

The basis in dealing with atopic dermatitis is gentle hygiene and daily skin care, which will rebuild the skin's protective barrier, and the skin will stop itching. Regularity and consistency are important. It is essenti alto maintain an appropriate skin care routine also during periods of skin improvement, to act preventively and extend the periods between exacerbations. Here are some important rules:

  • Take a shower instead of a bath, because staying in the water for too long can dry out your skin,
  • Remember to keep the water warm - hot water also dries the skin,
  • When washing, use mild gels or oils for atopic skin to reduce itching. Forget about regular soaps and bath lotions,
  • After washing, gently dry the skin with a towel - do not rub it,
  • Apply the emollient balm for atopic skin on the skin that is still slightly moist, it will rebuild the skin's protective barrier and reduce itching,
  • If your skin is itchy, always have an anti-itching spray for atopic skin with you - especially at night, by your bedside,
  • Wash your clothes and bedding in special powders for allergy sufferers or atopic people.

Atopic dermatitis - diagnosis

The doctor makes the diagnosisatopic dermatitisbased on the characteristic symptoms of the disease. There is no one diagnostic test that would confirm the diagnosis 100%. The so-called Hanifin-Rajka criteria. It is a set of 27 criteria (clinical symptoms) characteristic of atopic dermatitis.

Among them we distinguish 4 so-called the greater (main) criteria and 23 less (additional) criteria. To recognizeAZS , it is necessary to meet at least three major criteria and three smaller criteria.

Hanifin-Rajka criteria:

Major criteria include:

  • itchy skin
  • characteristic localization of skin lesions
  • atopy in the patient or his family
  • chronic and recurrent nature of the disease

The smaller criteria are:

  • dry skin (xerosis)
  • early age of onset
  • ichthyosis or follicular keratosis
  • positive skin prick test results
  • increased IgE concentration (atopy)
  • recurrent skin infections
  • non-specific eczema of hands and / or feet
  • nipple eczema
  • cheilitis
  • recurrent conjunctivitis
  • keratoconus (keratoconus)
  • subcapsular cataract
  • darkening around the eyes
  • Dennie and Morgan's symptom (eye crease)
  • white dermographism
  • anterior cervical fold
  • itchy skin after sweating
  • food intolerance
  • wool intolerance
  • exacerbation of the skin condition after stress
  • erythemaface
  • white dandruff
  • highlighting the hair follicles.

In the diagnosis of atopic dermatitis, allergy tests, such as the level of IgE antibodies in the blood, can be helpful. It is also possible to test the level of these antibodies against specific allergens. It allows to determine what exactly a given patient is allergic to.

Atopic dermatitis and the structure and functions of the skin

The skin is one of the largest organs in terms of surface area in our body - on average it occupies 1.5 to 2 m². There are three basic layers in the structure of the skin:

  • epidermis
  • dermis
  • subcutaneous tissue

Each of them is composed of a different type of cells. The outermost layer - the epidermis - is dominated by tightly adhering keratinocytes.

Their task is to create a tight barrier against the external environment. The epidermis also contains melanocytes, i.e. cells responsible for the color of the skin. Their number depends on the type of a person's complexion. The next layer, i.e. the dermis, is made primarily of connective tissue.

When examining a fragment of the dermis under a microscope, we can additionally notice various structures:

  • sweat glands
  • sebaceous glands
  • blood vessels
  • nerve endings
  • hair follicles

The subcutaneous tissue contains, among others, fat cells.

Of course, the structure of the skin varies depending on the region of our body. For example, there is no hair or sebaceous glands on the skin of the hand, but there is the greatest concentration of sweat glands in the entire body. The thickness of the epidermis also varies considerably, and in the area of ​​the heels it can be up to 2 mm thick.

It is worth realizing that the skin is not just a passive coating covering our body. This organ actively participates, for example, in the regulation of the body's temperature or the water and electrolyte balance. The skin acts as a barrier: it prevents excessive water loss, but also protects us against the negative effects of external factors.

Tight connections between the cells of the epidermis prevent the penetration of microorganisms. The skin is the site of vitamin D production, thus taking a significant part in the hormonal balance. The work of the cutaneous sweat glands is, in turn, one of the most effective mechanisms of thermoregulation.

Atopic dermatitis and atopy

The nameof atopic dermatitisincludes the term atopy, i.e.the underlying phenomena. So what is atopy? This name is used to describe an inborn predisposition to allergic reactions in response to various antigens. The immune system of a person with atopy is "shifted" towards allergic responses.

These patients have high levels of IgE antibodies in their blood, which are the main antibodies responsible for the development of allergies. In addition to atopic dermatitis, atopy may be associated with the presence of other allergic conditions:

  • bronchial asthma
  • allergic rhinitis
  • food allergies

These diseases can also coexist with each other.

What will a dermatologist help with?

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Allergies