Blog

How is atopic dermatitis diagnosed?

Atopic dermatitis is diagnosed by visual inspection of the skin by a family doctor or dermatologist, where the patient’s medical history as well as family history helps to make the diagnosis. When taking a medical history, doctors look for information about similar rashes and other health problems, including frequent inflammations, allergies, and asthma.

There is currently no specific test that ″ unequivocally ″ confirms that it is atopic dermatitis ″. A skin biopsy (a sample of a small piece of skin that is sent for examination under a microscope) can be useful in making a diagnosis in “severe cases“.

To rule out a skin infection, a swab is used that is taken with a gentle skin wrap (long cotton applicator or Q type). The sample is sent to a laboratory to rule out a skin infection that may mimic atopic dermatitis.

Although itching is the main symptom of the disease it is not possible to say that every itch is atopic dermatitis, itching can be seen in many other medical diseases. Doctors base the diagnosis on individual symptoms. It is important to rule out other diseases and / or conditions that can cause skin irritation.

An appropriate diagnostic tool is a medical history that provides important information about the disease. When taking a medical history, doctors examine the following: family history of allergic diseases, whether the patient has had diseases such as hay fever or asthma, whether he is exposed to irritants, whether he has sleep disorders due to itching, whether he suspects any food that could Being associated with skin inflammation, the doctor examines previous treatment of skin symptoms, steroid use and finally what the effects of the disease are on performance in school, the workplace, or how the disease affects social life. Sometimes it is necessary to do skin patch testing to determine if the skin’s immune system is hyperactive to certain chemicals or preservatives.

A preliminary diagnosis of atopic dermatitis can be made if the patient has three or more characteristics of two categories: large features and small features. Some of these characteristics are listed in the table below.

A skin scratch / prick test (which involves scratching or pricking the skin with a needle containing a small amount of a suspected allergen) and blood tests for a suspected allergen can help but are not as helpful in making a diagnosis as a medical history and symptom observation. These tests can help find a specific allergen that may be causing the disease. Negative skin test results are reliable and can help rule out certain substances that cause skin inflammation. On the contrary, a positive skin scratch / prick test is difficult to interpret in people with atopic dermatitis and is usually inaccurate. In some cases where the type of dermatitis is unclear, blood testing to check for eosinophil levels (a type of white blood cell) or IgE (for antibodies whose levels are usually high in atopic dermatitis) may be helpful.

Main and secondary signs of atopic dermatitis

The main signs of atopic dermatitis

• Itching
• Rash at a characteristic location (hand crease and back of the knee)
• Chronic or frequent onset of symptoms
• Personal or family history of atopic dermatitis (eczema, fever, asthma)

Some minor signs

• Beginning in the early years
• Dry, rough, skin

• Hyper linear palms
• Keratosis pilaris
• Dermatitis of the hands or feet
• Cheilitis (dry or irritated lips)
• Nipple eczema (eczema of the nipple of the breast)
• Suspicious skin infection
• Positive allergy skin test
• Hyper linear palms
• Keratosis pilaris
• Dermatitis of the hands or feet

What factors can worsen atopic dermatitis?

Many factors can worsen the symptoms of atopic dermatitis, including dry skin in winter or cold weather, woolen clothing, and other irritants. These factors can trigger an itchy-itchy cycle and stimulate an already overactive immune system in the skin. Repeated exacerbation and activation of the itchy-itchy cycle can cause further skin damage and break the skin barrier. These exacerbating elements can be classified into two main categories: irritants and allergens. Emotional factors in some infections can also worsen atopic dermatitis.

What are the irritants in patients with atopic dermatitis?

Irritants are substances that directly affect the skin and when used for a long time in high concentrations cause the skin to become red, itchy or inflamed. Specific irritants are characteristic of patients with atopic dermatitis. and their families learn to identify irritants that exacerbate their disease. For example, wool or synthetic fibers can cause atopic dermatitis. Rough or inappropriate clothing can irritate the skin, cause inflammation and start an itchy – itchy cycle. Soaps and detergents can have a drying effect and worsen itching while some perfumes and cosmetics can irritate the skin. Exposure to certain elements (eg chlorine, mineral oils or solvents) and irritants (eg dust or sand) can also make the disease worse. Cigarette smoking can irritate the eyelids.

The most common irritants

• Wool or synthetic fibers
• Soaps or detergents
• Some perfumes or cosmetics
• Chlorine, mineral oils, or solvents
• Dust or sand
• Dust mites
• Cigarette smoking
• Animal hair
• Flowers or pollen

What are allergens?

Allergens aresubstances from food, plants or animals that provoke an enhanced reaction of the immune system and cause inflammation (in this case the skin). Inflammation can occur when a person is exposed to a small amount of an allergen for a period of time. Some examples of allergens are dust and surface dead skin cells of dogs or cats (tiny parts of animal skin or hair). Certain foods (allergens) can trigger atopic dermatitis or exacerbate it (make it worse). Food allergens play a role in many cases of atopic dermatitis, primarily in infants and young children. The most common allergen – causing (allergen) foods are eggs, peanuts, milk, fish, soy products, and wheat. Some studies suggest that mothers with a family history of atopic dermatitis should avoid consuming allergic foods especially during late pregnancy and breastfeeding. Likewise, most experts think that if a mother breastfeeds a child for at least four months, it has a protective effect on the child.

If a food allergy is suspected, it is necessary to pay attention to the patient’s daily diet. Identifying food allergens can be difficult and sometimes it is necessary to seek the help of an allergist. The way to investigate food allergy is to eliminate suspicious food and if improvement is noted it is necessary to introduce the found food into the diet. Two weeks of rehearsal is usually enough for each food. If the suspected food does not cause symptoms after two weeks the different foods can be subsequently tested like the suspected one.

The introduction of a diet does not always lead to a cure. Restrictive diets are usually emotionally and financially difficult for both the individual and their family. A diet with a lot of restrictions can cause nutritional problems in children.

What are aeroallergens?

Some allergens are called aeroallergens because they are present in the air. They may also play a role in atopic dermatitis. Common aeroallergens are house dust, pollen, mold, and dead cells from animal hair or skin. Doctors may recommend measures that will reduce exposure to the aeroallergen found. For example, the impact of house dust mites can be limited by an anti-allergy cover or a pillow in a special dust-protected pillowcase, frequent washing of bedding in warm water or moving carpets out of the apartment. However, there is no way to completely rid the environment of aeroallergens.

What other factors may play a role in atopic dermatitis?

In addition to irritants and classic allergens, other factors such as emotional stress, ambient temperature, climate, and skin infections can worsen atopic dermatitis. Although the disease itself is not caused by an emotional factor or personality it can exacerbatein stress, anger, and frustration. Interpersonal problems or major changes such as divorce, job change, or the death of a loved one can also make the disease worse. Usually emotional stress makes the disease promptly worsen.

Bathing with intense soaps without proper moisturizing is a subsequent common factor that causes inflammation in atopic dermatitis. Typical recommendations include the use of very gentle, mild soaps such as Dove, Cetaphil or Aquanil. After washing or bathing, the skin should be coated with rich moisturizers (emollients) such as Vaseline, Aquaphor or Crisco.

Low humidity in winter or a dry year, some geographical areas, overheated interiors and prolonged or hot baths and showers can make the disease worse. On the other hand sweating and cold, bacterial infections can also increase the severity of atopic dermatitis. If the patient’s condition suddenly worsens, a viral infection (such as herpes simplex) or a fungal infection (such as tinea or athletic foot) should be suspected.

How is atopic dermatitis treated?

Treatment involves cooperation between the doctor and the patient as well as members of his family. Physicians provide a treatment plan based on the patient’s age, symptoms, and general condition. Patients and their family members play a major role in successful treatment planning by carefully following the physician’s instructions. Most patients have excellent results with proper skin care and lifestyle changes and do not require other treatments. The greatest improvement is achieved with proper skin care at home including copious moisturizing of the skin especially immediately after bathing or showering.

Doctors have three main goals in treating atopic dermatitis:

1. Healing the skin and preserving its integrity
2. Inflammation prevention
3. Treatment of symptoms

The greatest benefits for the skin are the following activities:

1. Skin care
2. Exacerbation factor identification program
3. Avoiding the possibility of stimulating the skin’s immune system and itching itching cycles

In skin care, simplicity is the key to success. It is important to use one recommended soap and one moisturizer. The use of various soaps, lotions and fragrances can cause further damage and sensitivity of the skin.

Healing the skin and maintaining it as such is the primary task in preventing further damage and preserving the integrity of the skin. The key factors are proper baths and application of lubricants (such as creams or ointments) within three minutes after bathing. People with atopic dermatitis should avoid a hot or long-lasting (more than 10 to 15 minutes) bath or prolonged showering. A mild bath helps to cleanse and moisturize the skin without excessive drying.

Once the bath is complete the patient should air dry the skin or pat it gently (avoiding rubbing). Lubricants compensate for skin moisture by accelerating healing and set a protective barrier against further drying and irritation. There are several types of lubricants. Lotions are generally not the best choice as they have a lot of water or alcohol in their composition and evaporate quickly, while creams and ointments are better and heal the skin. Tar preparations can be very useful in healing very dry lichenified areas. Each preparation chosen should, as far as possible, be odorless and chemical-free.

Another way to protect and regenerate the skin is to take steps to avoid recurrent skin infections. Although it is not possible to avoid infection, the effect of the infection can be minimized if it is identified and treated early.

Treatment of atopic dermatitis in neonates and children

Giving short written instructions,

• Lukewarm baths
• Application of lubricant immediately after the bath
• Keep baby’s fingernails cut short
• Use clothes made of soft cotton fabrics
• Use of antihistamines to reduce itching (especially at night)
• Keep children in cooler rooms, avoid overheated rooms and baths
• Teach children to recognize a possible skin infection and treat it quickly
• Try to distract the child from the disease to keep him from scratching.

Medications and Phototherapy: There are several methods that can be used to treat symptoms. With proper treatment, most symptoms can be brought under control within three weeks. If symptoms do not subside despite treatment, it may be due to excessive inflammation that cannot be controlled with medication, if the treatment program does not suit certain individuals, or if unrecognized trigger factors are present. These factors may also include a reaction to medications, infections, or emotional stress. Continuous symptoms may also occur because the patient did not follow the instructions of the treatment program.

Corticosteroid creams and ointments are the most common in treatment, they are used in various forms but in many cases strong corticosteroid creams are used. Side effects of repeated or long-term use of topical corticosteroids may include thinning of the skin, infection, growth suppression (in children), and stretching of the skin.

Tacrolimus (Protopic) and Pimecrolimus (Elidel) are medical creams that are applied topically to the skin. These are new drugs and are called immunomodulators that were first used in oral form to help patients with a kidney or liver transplant to avoid organ rejection. Unlike topical steroids (cortisone creams), these drugs do not cause thinning of the skin and do not interrupt the surface blood flow.

Atopiclair and Mimyx are sometimes used to improve the skin’s protectivebarrier in children and adults. These creams can be used in combination with topical steroids and other emollients to help remove excessive dryness and restore damaged skin function.

Additional available treatment can help reduce the specific symptoms of the disease. Antibiotics to treat the disease can be applied directly to the skin in the form of ointments but are usually more effective when taken orally in pill form. Certain antihistamines that cause drowsiness can reduce itching during the night and support restful sleep. This effect may be partially beneficial for a patient whose nocturnal scratching exacerbates the disease. If a viral or fungal infection is present on atopic skin, your doctor may also prescribe medications to treat those infections.

Phototherapy is a light treatment that uses ultraviolet A or B light rays or a combination thereof. This treatment can be an effective treatment for mild or moderate dermatitis in older children (over 12 years of age) and adults. Photochemotherapyis a combination of ultraviolet light therapy and a drug called psoralen, and is used in cases that are resistant to phototherapy. Possible long-term side effects of this treatment include premature skin aging and skin cancer.

When other medications are not effective, your doctor may prescribe systemic corticosteroid medications that are taken by mouth or injected into the muscles instead of being applied to the skin. For example, the most commonly prescribed corticosteroid is prednisone. These drugs are used only in resistant cases and are given only briefly. Side effects of systemic corticosteroids may include skin damage, thinning or weakening of the bones, high blood pressure, high blood sugar, infections and cataracts. It is very dangerous to suddenly stop taking corticosteroids, so your doctor should change your corticosteroid doses carefully.

In adults, immunosuppressive drugs such as Cyclosporin are used to treat severe cases of atopic dermatitis. Immunosuppressivedrugs block the hyperactive immune system by inhibiting the production of immune cells. Side effects of cyclosporine include high blood pressure, vomiting, nausea, kidney problems, headaches, stiffness, and the risk of getting tumors and infections. There is also a risk of relapse after stopping the medication. Due to toxic side effects, systemic corticosteroids and immunosuppressive drugs are used only in severe cases and then very briefly.

In extremely rare cases when other treatments are not successful the patient must be hospitalized where he remains for five to seven days with intensive treatment and avoidance of exposure to irritants, allergens and psychological stresses.

What to do when visiting a doctor?

Provide complete and accurate medical records about you and your child

• Make a list of questions in advance
• Be honest and share your points of view with your doctor
• Ask for an explanation or further clarification
• Talk to other members of the healthcare team such as nurses, therapists or pharmacists
• In conversation, do not hesitate to discuss sensitive matters
• Discuss other treatments or medications before using it.

Atopic dermatitis and quality of life

Despite the symptoms caused by atopic dermatitis, it is possible to maintain a quality of life. The key to improving the quality of life is education, information and the development of a partnership between the patient, family and doctor. Good communication is the basis for developing a partnership between the patient, family and doctor.

When a child has atopic dermatitis the condition in the family can get worse. It is therefore important that families have additional support to help her cope with the stress and frustration associated with the illness. A child can be restless and it is usually impossible to prevent him from scratching and rubbing his skin. Distracting the child and providing many activities that keep the hands busy is key but requires a lot of effort and work for the parent or caregiver. The child may face difficulties at school or other social relationships and needs additional support and encouragement from family members.

Adults with atopic dermatitis can improve their quality of life with proper skin care as well as eliminating other symptoms of the disease and proper treatment. Adults should approach skin care on a daily basis. Relaxation techniques can help reduce the inflammation caused by emotional stress. Developing a support network that includes family, friends, health professionals, and group support or organizations can be helpful. Chronic lethargy and depression can be relieved by short psychotherapy.

One should accept the fact that scratching is the most typical symptom of atopic dermatitis. For example, many patients find that they itch more than necessary most often when they are unemployed. Various activities that keep their hands busy can prevent further skin damage. Occupational counseling can also be helpful to change occupation if it involves contact with irritants or involves frequent hand washing such as working in the kitchen or car mechanic work.

Controlling atopic dermatitis

• Frequent moisturizing of the skin
• Avoid harsh soaps and cleaners
• Prevent scratching or rubbing whenever possible
• Protect your skin from excessive moisture, irritation and rough clothing
• Maintain a cool, stable temperature and a stable humidity level
• Limit exposure to dust, cigarette smoke, pollen, and animal hair.
• Accept and limit emotional stress

What is the long-term prognosis of atopic dermatitis?

Although the symptoms of atopic dermatitis can be very severe and the unpleasant disease can be successfully controlled. People with atopic dermatitis as well as their families can lead to a healthier, normal life. Long-term follow-up may involve a specialist allergist to control allergies in the body and a dermatologist to control the skin.

Atopic dermatitis in brief

• Atopic dermatitis is a type of eczema
• Skin susceptibility to these diseases can be hereditary and genetically determined
• The patient’s skin can be “super sensitive” to many irritants
• Dry scaly spots develop in a characteristic distribution
• The itching varies but can be intense and resistant to severe itching
• Itching can cause thinning and darkening of the skin and lead to further complications including bacterial infections.
• Extremely dry skin can crack, leak or exudate.
• If the itching can be controlled, then the rash (which worsens with strong itching) is also easier to control.
• Treatment of atopic dermatitis is based on skin rehydration with rich moisturizers like Vaseline and careful use of topical steroids that reduce inflammation and itching.
• Oral antihistamines are usually necessary to interrupt the itchy-itchy cycle.
• Because secondary infection may exacerbate the rash, topical or oral antibiotics may also be indicated from time to time.

Keywords: Atopic dermatitis, itching, itching, irritants, allergens, skin care, phototherapy, topical corticosteroids,