It is a common skin condition in infants and has been extensively researched yet the exact cause of atopic dermatitis is unknown. The condition can be frustrating for parents as the symptoms can be unbearable for the child. The focus is on managing the condition by relieving symptoms, protecting the skin and avoiding dietary and lifestyle factors that may exacerbate the symptoms.
What is atopic dermatitis?
Atopic dermatitis is an itchy skin condition that usually starts early in life. There is a variant that can start in adulthood. Atopic dermatitis is commonly known as eczema although this term can refer to any type of dermatitis. It is linked to allergic diseases like allergic rhinitis (sometimes referred to as hay fever) and asthma. Atopic dermatitis affects between 10% to 12% of children and less than 1% of adults. The majority of cases start in the first year of life.
The exact cause of atopic dermatitis is unknown. Recent findings have shown that the use of probiotics by pregnant and breastfeeding mothers as well as their infants may reduce the development of atopic dermatitis. Dietary changes may be of some benefit but the link between foods and atopic dermatitis is inconclusive. However, there are various other factors that play a possible role in the development of atopic dermatitis. Treatment focuses on long term management and the condition often resolves spontaneously as a child grows older.
Causes of Atopic Dermatitis
Atopic dermatitis is an inflammatory skin condition that appears to be due to a combination of intrinsic and extrinsic factors. . The exact reason for this inflammation is unclear. It is believed that the immune system is dysfunctional or some abnormality in the skin allows for immune triggers (bacteria, allergens and irritants) to enter thereby eliciting a response from the immune system. Inflammation is the consequence. The resulting dryness of the skin may further increase the likelihood of the underlying problem continuing or compounding.
There have been a number of risk factors identified in atopic dermatitis. It is important to note that risk factors are not always the cause of atopic dermatitis. Instead it is the factor(s) that increases the likelihood of the condition occurring. Not all people who have one or more of these risk factors will definitely lead to the development of atopic dermatitis.
A family history of atopic dermatitis and related allergic diseases is a common risk factor. This includes parents and siblings who with a history of atopic dermatitis in early life.
One hypothesis revolves around the theory that reduced exposure to infectious agents in childhood, including bacterial toxins, may play a role in the development of atopic dermatitis.
Atopic dermatitis is not an infectious condition. However, it is believed that certain bacterial species like Staphylococcus aureus may be one of the immune triggers (antigens) as discussed above.
Heat, cold and dryness leading to sweating and dry skin may play a role in the development of atopic dermatitis. These factors also exacerbate the condition.
Some studies have shown a link between tobacco smoke exposure and atopic dermatitis. The link appears to relate adult-onset atopic dermatitis even if tobacco exposure has been in childhood.
Signs and Symptoms
Itching is the main symptom. It often precedes the onset of any visible skin rash and continues thereafter. The rash appears as very dry skin which is red and swollen. There may be small bumps which may be oozing. The areas may become raw from scratching and even bleed. Pain is more likely in these cases. The skin becomes thickened, dry, scaly and leathery over time. The patch becomes a darker brown over time.
The rash can occur throughout the body but is usually limited in patches to certain areas. Atopic dermatitis tends to affect the folds of the skin like the elbows and behind the knees. It tends to occur on the following areas.
- Head (scalp, forehead, cheeks)
- Arms (elbows and forearms)
- Legs (behind knees and lower legs)
- Buttock-thigh creases
Certain factors can worsen the symptoms, particularly itching.
- Heat including hot weather and hot baths.
- Psychological stress
- Wool clothing, toys, blankets
- Detergents and soaps
- Certain foods – milk, eggs, soy, wheat, peanuts
Pictures of Atopic Dermatitis
Treatment of Atopic Dermatitis
There is no known cure for atopic dermatitis. Treatment focuses on manging the condition. Management includes ongoing lifestyle and possibly dietary changes. Since it can persist for months and often for years, management is ongoing. It focuses on relieving the symptoms, treating complications and aiding the skin with healing.
- Antihistamines to reduce itching.
- Corticosteroids to reduce inflammation. May be used as a topical application (creams or ointments) or orally.
- Calcineurin inhibitors are used as topical applications to maintain normal skin and reduce inflammation.
- Antibiotics for bacterial infections of the affected skin.
Barrier creams are essential for protecting the skin from the environment. It also helps the skin retain any moisture that may be present. Moisturisers are also needed to remedy the dryness of the skin. However, the moisture is lost rapidly and it therefore has to be applied repeatedly. Other treatment options may include probiotics and UV light therapy.
Diet for Atopic Dermatitis
Dietary options for infants may be limited especially under 6 months of age. There may be upcoming recommendations for the inclusion of probiotics in baby formula along with probiotics for breastfeeding mothers. There is still some controversy regarding the role of certain foods in the development of atopic dermatitis. Since people with atopic dermatitis are prone to developing allergic conditions like urticaria (hives) and anaphylactic reactions, dietary changes may be a help in preventing these conditions.
However, it has been noted that certain foods can exacerbate the symptoms of atopic dermatitis. Peanuts, milk, wheat, eggs, soybeans and seafoods are some of the foods that should be avoided both for exacerbating the conditions as well as possibly lead to other allergic conditions. Dietary changes should be made in consultation with a registered dietitian to ensure adequate nutrition for the growing child while avoiding problem foods.