yulius hermanto
Atopic Dermatitis at a Glance
Introduction
Atopic dermatitis is an acute, subacute or chronic relapsing skin disorder that cause by our body hypersensitivity reaction that manifests to the skin or in simple words, atopic dermatitis is skin manifestations of allergy.
When we hear about allergy, first though in our mind is pruritus of the skin after eating something. Well, from that, we can see that most of us already know what is atopic dermatitis.
Atopic dermatitis is common disease especially during childhood. It is usually begin in infancy, the incidence of atopic dermatitis decreased along with increasing of ages. It is estimated about 20-30% in early childhood, but atopic dermatitis becomes a rare disease in adult.
Allergic reaction in atopic dermatitis, has many factors that involved in. One of them is family history. Allergy related disease such as atopic dermatitis, asthma, is believed to have genetic predispositions. Eventhough environmental factors also determine the outcomes.
The decreasing incidence of atopic dermatitis along with ages, until know is not well explained. The concept is related to our immune system maturations that will be shown as a curve of allergic march. Most of child with atopic dermatitis may cure spontaneous, but may undergo another kind of allergic disease such as asthma or allergic rhinitis.
Eliciting factors
Inhalants, specific aeroallergens, especially dust mites and pollens, have been shown to cause exacerbations of atopic dermatitis.
Mircobial agents, several infections, may stimulate activation of allergic reaction.
Food, subsets of infants and children have flares of atopic dermatitis with eggs, milk, peanuts, soybeans, fish and wheat.
Other factors that can contribute as exacerbating factors such as cold weather, dehidration, and emotional stress.
Pathogenesis
Allergic reaction in atopic dermatitis, basically is same with others atopic disease such asthma and allergic rhinitis. There is a complex interaction between genetic, environment, and immunologic factors that happens inside the skin.
IgE and histamines play role in skin inflammation of atopic dermatitis, that being activated by several exacerbating factors. Allergen binding with IgE causing histamine release from inflammatory cells, mediates tissue response.
Clinical Manifestations
Skin symptoms most patients have dry skin. Pruritius is the sine qua non of atopic dermatitis - "eczema is the itch that rashes. The constant scratching leads to a vicious cycle of itch --> scratch --> rash --> itch --> scrath.
Course and Prognosis
Untreated involved sites persists for months or years. Spontaneous, more or less complete remission during childhood occurs in >40% cases. In many patients, the disease persists for 15-20 years, but is less severe. From 30-50% of patients develop asthma or hay fever.
Management
Basic of allergic treatment is Avoidance.
It is important for someone with atopic disease, recognize the exacerbating factors and avoid thus factors.
Avoidance not only useful in prevention of atopy recurrence but also helpful in treatment since the stimulate factors is being removed or minimalized. In this case, with disturbing symptoms, atopic dermatitis will be treated with several drugs depends on severity and course of the disease.
Most of patients can't easily avoid the allergen since the allergen is around them, such as the pollen, dust mites. These patients will be helpful if given a pharmacotherapy compare to the patients that allergen is food, that can easily avoid.
When a patient is diagnosed atopic dermatitis, it would be better if patient undergo allergen identifying by patch skin test, thus will identify what kind of allergen that a person is sensitive, thus will be helpful in prevention.
Pruritus or itching is the most incomfortable symptoms of atopic dermatitis thus give impact to the quality of life and also as risk factors for skin infection from epithelial tear by scratching.
Rubbing and Scratching needs to be avoided in management of symptomatic atopic dermatitis. Topical antipruritic agents such as menthol is helpful in controlling the symptoms.
Another topical applicants that is important in atopic dermatitis is emoliens, in order to prevent skin dehidration, thus prevent the exacerbation.
Oral antihistamines can be used to reduced the pruritus and minimalized the scratching, in order to prevent the skin infection.
In some cases, with skin infection, topical antibiotic or oral antibiotic will be prescribed. Steroids usages in atopic dermatitis mostly topical, except in severe cases, because the side-effects of steroids such as osteoporosis, cataract, cushing syndrome and hyperglicemia.
For more explanation of atopic dermatitis and its treatment, someone can consult with the doctor and discuss about their conditions and modalities of the treatment.
Atopic disease maybe disturb someone daily activities, and impair their quality of life. But, it is a sign for someone with atopic to move to the another place that is better. Because, most of atopic patients can achieved remissions while they move from their previous place of living.
Atopic dermatitis is an acute, subacute or chronic relapsing skin disorder that cause by our body hypersensitivity reaction that manifests to the skin or in simple words, atopic dermatitis is skin manifestations of allergy.
When we hear about allergy, first though in our mind is pruritus of the skin after eating something. Well, from that, we can see that most of us already know what is atopic dermatitis.
Allergic reaction in atopic dermatitis, has many factors that involved in. One of them is family history. Allergy related disease such as atopic dermatitis, asthma, is believed to have genetic predispositions. Eventhough environmental factors also determine the outcomes.
The decreasing incidence of atopic dermatitis along with ages, until know is not well explained. The concept is related to our immune system maturations that will be shown as a curve of allergic march. Most of child with atopic dermatitis may cure spontaneous, but may undergo another kind of allergic disease such as asthma or allergic rhinitis.
Eliciting factors
Inhalants, specific aeroallergens, especially dust mites and pollens, have been shown to cause exacerbations of atopic dermatitis.
Mircobial agents, several infections, may stimulate activation of allergic reaction.
Food, subsets of infants and children have flares of atopic dermatitis with eggs, milk, peanuts, soybeans, fish and wheat.
Other factors that can contribute as exacerbating factors such as cold weather, dehidration, and emotional stress.
Pathogenesis
Allergic reaction in atopic dermatitis, basically is same with others atopic disease such asthma and allergic rhinitis. There is a complex interaction between genetic, environment, and immunologic factors that happens inside the skin.
IgE and histamines play role in skin inflammation of atopic dermatitis, that being activated by several exacerbating factors. Allergen binding with IgE causing histamine release from inflammatory cells, mediates tissue response.
Clinical Manifestations
Skin symptoms most patients have dry skin. Pruritius is the sine qua non of atopic dermatitis - "eczema is the itch that rashes. The constant scratching leads to a vicious cycle of itch --> scratch --> rash --> itch --> scrath.
Course and Prognosis
Untreated involved sites persists for months or years. Spontaneous, more or less complete remission during childhood occurs in >40% cases. In many patients, the disease persists for 15-20 years, but is less severe. From 30-50% of patients develop asthma or hay fever.
Management
Basic of allergic treatment is Avoidance.
It is important for someone with atopic disease, recognize the exacerbating factors and avoid thus factors.
Avoidance not only useful in prevention of atopy recurrence but also helpful in treatment since the stimulate factors is being removed or minimalized. In this case, with disturbing symptoms, atopic dermatitis will be treated with several drugs depends on severity and course of the disease.
Most of patients can't easily avoid the allergen since the allergen is around them, such as the pollen, dust mites. These patients will be helpful if given a pharmacotherapy compare to the patients that allergen is food, that can easily avoid.
When a patient is diagnosed atopic dermatitis, it would be better if patient undergo allergen identifying by patch skin test, thus will identify what kind of allergen that a person is sensitive, thus will be helpful in prevention.
Pruritus or itching is the most incomfortable symptoms of atopic dermatitis thus give impact to the quality of life and also as risk factors for skin infection from epithelial tear by scratching.
Rubbing and Scratching needs to be avoided in management of symptomatic atopic dermatitis. Topical antipruritic agents such as menthol is helpful in controlling the symptoms.
Another topical applicants that is important in atopic dermatitis is emoliens, in order to prevent skin dehidration, thus prevent the exacerbation.
Oral antihistamines can be used to reduced the pruritus and minimalized the scratching, in order to prevent the skin infection.
In some cases, with skin infection, topical antibiotic or oral antibiotic will be prescribed. Steroids usages in atopic dermatitis mostly topical, except in severe cases, because the side-effects of steroids such as osteoporosis, cataract, cushing syndrome and hyperglicemia.
For more explanation of atopic dermatitis and its treatment, someone can consult with the doctor and discuss about their conditions and modalities of the treatment.
Atopic disease maybe disturb someone daily activities, and impair their quality of life. But, it is a sign for someone with atopic to move to the another place that is better. Because, most of atopic patients can achieved remissions while they move from their previous place of living.
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