Atopic Dermatitis

Atopic dermatitis, or atopic eczema, is a chronic inflammatory and pruritic (itchy) disease that affects the superficial layers of the skin. It typically presents in flare-ups, meaning intermittently, though more severe cases may present continuously.

It is one of the most common skin diseases, typically beginning in early childhood and can persist into adulthood, although it usually disappears or decreases with time. It may also appear for the first time in adults and is one of the most common occupational conditions.

Although it is a benign, non-contagious disorder, it can be very bothersome.

Symptoms

The characteristic symptoms of atopic dermatitis include:

• Skin rashes:
• In babies, eczema can affect large areas of the skin and spread to the face, neck, eyelids, scalp, hands, arms, feet, and legs.
• In children and adults, it appears only in specific areas, especially the front of the neck, the folds of the elbows, and the area behind the knees.
• Pruritus: Intense, constant itching.
• Dry and irritated skin.
• Blisters that ooze and form crusts due to scratching.
• Redness or inflammation around the blisters.
• Peeling or excoriations caused by scratching.

Causes

There are several hypotheses that explain the onset of atopic dermatitis:

• Genetics: Mutations in certain genes disrupt the skin barrier and cause chronic inflammation. The gene most commonly associated is FLG, responsible for encoding the profilaggrin protein (which contributes to the synthesis of the outer skin layer that minimizes water loss and prevents the entry of foreign substances). In very rare cases, it has been associated with mutations in the CARD11 gene, which encodes a protein involved in lymphocyte function, responsible for identifying and combating threats.
• Bacterial infection: Most individuals with atopic dermatitis show an increase in the number of colonies of the Staphylococcus aureus bacteria, whose toxins alter the skin's protective function and contribute to symptom exacerbation.
• Overactivation of the immune system: There is an imbalance in cytokine and lymphocyte function, which increases sensitivity, causing the immune system to react to non-harmful substances, such as allergens, leading to inflammation.
• Environmental factors: While not causing dermatitis, these factors trigger flare-ups. The most common include strong soaps and detergents, sweating, cold and dry air, rough fabrics, wool, chemicals, dust mites, pet dander, mold, pollen, tobacco smoke, perfumes, or emotional stress.

Risk Factors

The main risk factor for developing atopic dermatitis is a family or personal history of dermatitis, allergies, rhinitis, or asthma.

Complications

The most common complications of atopic dermatitis arise from constant scratching due to intense itching:

• Thickening or lichenification: The skin develops a leathery texture with accentuated folds and wrinkles.
• Erythroderma: A process of peeling, shedding, and exfoliating of the skin.
• Infections: Favored by skin erosion. They can occur in the skin, underlying tissues, and surrounding lymph nodes. The extent of these infections can be potentially fatal.
• Anxiety or depression: Resulting from sleep disruption caused by intense, chronic itching.

People with atopic dermatitis also have a strong predisposition to develop asthma, hay fever (rhinitis), and allergies, including food allergies and sensitivities to dust mites, pollen, and other inhaled allergens. These multiple sensitivities complicate flare-up management. Atopic dermatitis is also frequently accompanied by irritant contact dermatitis or allergic contact dermatitis, caused by hypersensitivity and exposure to specific irritants, which commonly affect workers in cleaning, metallurgy, healthcare, and cosmetics industries.

Prevention

Atopic dermatitis cannot be prevented, but certain measures can be taken to reduce the frequency and intensity of flare-ups:

• Use special hygiene and personal care products for atopic skin, free from alcohol and fragrance.
• Keep the skin moisturized by applying creams on damp skin.
• Wear clothing made from natural, hypoallergenic fabrics, such as cotton or linen.
• Avoid dust accumulation in the home.
• Take short showers with warm water, without scrubbing with a sponge, and gently pat skin dry.
• Shower after exercise to remove sweat.
• Avoid using fabric softeners.
• Use sunscreen creams.
• Avoid exposure to extreme temperatures.
• Avoid irritants such as cleaning products. When using them, protect the hands with rubber gloves over cotton ones, especially for products handled in the workplace.

Which doctor treats atopic dermatitis?

Atopic dermatitis is evaluated and treated by specialists in dermatology, allergy, and occupational medicine.