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Atopic dermatitis usually occurs in infants, but not exclusively. Atopic dermatitis (AD) is a chronic dermatological disease that affects up to 15-30% of children and 2-10% of adults. This disease may be associated not only with the involvement of the skin in typical places such as joint flexions, but also with the involvement of the hairy scalp. How does atopic dermatitis manifest itself and what are the treatment options for this condition?

Atopic dermatitisis a chronic inflammatory skin disease that typically appears during childhood. Genetic, immunological and environmental factors play a significant role in its pathogenesis. It is most often manifested by eczema, pruritus and lichenization. In severe cases, eczema can affect all areas of the body, includinghairy scalp . It is worth mentioning that generalized skin involvement throughout the body is called erythroderma.

Atopic dermatitis - symptoms

Eczema lesions around the scalp are considered typical of infants, but you should be aware that they can also appear in this area in older patients.

The most important symptoms of atopic dermatitisare:

  • presence of eczematous lesions- their localization varies depending on the patient's age. In infants, eczema lesions typically appearon the face , while in older children, they most often affect the skin in the area of ​​ joint bends :
    • wrist,
    • elbow
    • and knee.
    In adult patients, the backs of the hands are also often affected.
  • intense itching- this disease is accompanied by persistent itching, which leads to the appearance ofcuts(scratches) on the skin. Itching in the course of AD significantly worsens the patients' quality of life. It can also lead to sleep disorders and mood disorders, including depression.
  • lichenization- which is manifested by a clinically significant thickening of the epidermis, when viewing the affected areas you have the impression that you are looking at the skin through a magnifying glass. Severe lichenization mainly affects adults,suffering from chronic eczema.

Atopic dermatitis is mainly characterized by :

  • presence of erythematous-papular lesions on the scalp, which are typically bright red,
  • the presence of cross-cuts, i.e. mechanical injuries caused by scratching,
  • presence of erosions, i.e. epidermal defects,
  • scabs covering erythematous-papular changes,
  • thickening of the skin and its lichenization - these changes can be observed especially around the patient's neck,
  • dry hair, brittleness and a tendency to fall out,
  • lowering the hairline on the forehead,
  • accompanying skin involvement within the auricles.

Regarding the seizure of the scalp disease, it is worth mentioning the so-calledHertogh symptom , i.e.eyebrow thinning , especially in their of the outer part.

Another characteristic symptom of AD is the appearance ofpolished nail symptom , which results from intense itching and scratching of the skin.

Atopic dermatitis - causes

The causes of eczema lesions in the area of ​​the scalp coincide with the general causes of atopic dermatitis. The reasons for the appearance of this disease are believed mainly in:

  • genetic predispositionj - which is confirmed by the fact that the risk of AD in fraternal twins is 20-30%, and in identical twins - even 70%. The genetic predisposition to develop AD is polygenic - there is no one specific gene that would be responsible for the occurrence of this disease.
  • immune disorders- patients with AD are hypersensitive to various extrinsic and intrinsic antigens. Moreover, increased activity of Th2 lymphocytes is also observed as compared to Th1 lymphocytes, which results in a weaker local response to bacterial and viral antigens and a tendency to skin colonization by microorganisms.
  • epidermal barrier defect- in patients with AD, we are dealing with abnormal functioning and structure of the epidermis. This leads to excessive water loss, which causes the skin to dry out. Moreover, the skin of AD patients is more sensitive to allergens and irritants - the impairment of the epidermal barrier means that more antigens penetrate deep into the skin.

AZS and environmental factors

The causes of atopic dermatitis are not only genetics and immunology. The appearance of this disease is also influenced by environmental factors such aslike:

  • environmental pollution -these pollutants can impair the body's immune mechanisms. It is mainly about:
    • exhaust fumes,
    • pesticides,
    • herbicides.
  • airborne allergens- skin contact with these allergens may contribute to the appearance of skin lesions typical of atopic dermatitis. This is primarily about:
    • house dust mite,
    • grass and grain pollen,
    • whether animal hair.
  • psychogenic factors, stress- emotional overload is a significant risk factor of disease exacerbations.

Atopic dermatitis and fungal infection

Eczema lesions located on the scalp may be related to infection with fungi of the genus Malassezia furfur and Candida albicans.

Due to damage to the epidermal barrier, these fungi can become allergens that stimulate the body's immune response.

The role of these species of fungi in causing AD symptoms is confirmed by the fact that in clinical trials, antifungal treatment led to an improvement in the clinical condition of patients.

Atopic dermatitis - local treatment

In the treatment of atopic dermatitis, topical preparations are used, such as:

  • calcineurin inhibitors(tacrolimus, pimecrolimus) - these are drugs with immunomodulatory and anti-inflammatory properties. They are an alternative to topical steroids in the case of lesions located on the skin of the neck, face or head. These drugs are in the form of a cream or ointment, which makes them unsuitable for use on hairy skin.
  • topical steroids- they are still the most popular skin preparations. It should be remembered that the chronic use of topical steroids can be associated with many side effects, including the appearance of stretch marks, perioral inflammation, skin atrophy, rosacea, or slowing wound healing.
  • preparations containing e.g. 3% polidocanol- they are used to reduce troublesome itching.

Atopic dermatitis - general treatment

The choice of a specific drug in the treatment of atopic dermatitis depends primarily on the patient's clinical condition and preferences.

General medications are used mainly in the treatment of moderate and severe AD, when local treatment does not give the desired results.

In general treatment, the following are used, among others:

  • antihistamines-primarily have an anti-itching effect. The most commonly used substances are hydroxyzine, loratadine or cetirizine.
  • cyclosporine- it is a drug recommended in severe AD. Cyclosporine has a strong immunosuppressive effect, reduces inflammation, reduces itching, and reduces skin changes.
  • methotrexate- an immunosuppressive drug that works by inhibiting DNA synthesis. Its use is recommended in severe disease. Methotrexate may be associated with side effects such as liver, kidney and bone marrow damage.
  • azathioprine- an immunosuppressive drug, the action of which is based on a disturbance in DNA synthesis. Bone marrow function should be monitored during treatment with azathioprine.
  • biological treatment- involving the use of antibodies such as omalizumab, efalizumab and TNF-ɤ antagonists.

Atopic dermatitis - skin care

Proper care is extremely important in the treatment of atopic dermatitis. Remember to use cleansing preparations intended for sensitive and atopic skin. It is recommended to choose detergent-free shampoos.

Moreover, you should avoid excessive towel-rubbing of your hair and scalp. If you have any doubts about scalp care, consult a dermatologist. It is this specialist who treats patients with atopic dermatitis.

  • Atopic Dermatitis: Causes, Symptoms, and Treatment
  • Atopic dermatitis (AD): how to care for your skin

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