Atopic Dermatitis (Eczema): Symptoms, Diagnosis and Management

Atopic Dermatitis, commonly known as eczema, is a chronic skin condition that affects a significant number of people worldwide. This inflammatory disease is characterised by redness, itching, and scaling of the skin, often causing discomfort and impacting the quality of life of those affected.
Atopic Dermatitis is not limited to any particular age group or gender. It is a condition that can start in childhood and persist into adulthood, affecting daily life and activities.

Atopic Dermatitis is a chronic disease that causes inflammation, redness, and irritation of the skin. It is not contagious, meaning it cannot be spread from person to person. The most common symptom of Atopic Dermatitis is itching, which can be severe. Other symptoms include redness, swelling, cracking, and "weeping" clear fluid.

Symptoms

Key symptoms of Atopic Dermatitis include severe itching, redness, swelling, and cracking of the skin. There may also be an extra fold of skin under the eye, known as a Dennie-Morgan fold, and darkening of the skin beneath the eyes.

Causes

The exact cause of Atopic Dermatitis is unknown, but it is believed to be a combination of genetic and environmental factors. These may include exposure to tobacco smoke, certain types of air pollutants, fragrances, and other compounds found in skin products and soaps, and excessively dry skin.

"An alteration in a gene that is important for maintaining a healthy skin barrier has been closely linked to the development of eczema. This makes the skin of patients affected by eczema much more susceptible to infection and allows irritating substances/particles to enter the skin, causing itching and inflammation" - British Association of Dermatologists

Impact and Complications

If left untreated, Atopic Dermatitis can lead to further skin complications such as infection due to constant scratching. It can also lead to sleep loss, depression, or anxiety due to the discomfort and itchiness.

At risk groups

• Individuals with a family history of eczema, hay fever, or asthma
• Individuals diagnosed with another atopic illness i.e. asthma or hay fever

Importance of Treatment

Treatment is crucial to manage symptoms, prevent flare-ups, and improve the quality of life of those affected.

Diagnosis

The diagnosis of atopic dermatitis typically involves the following steps:
1. Medical History and Physical Examination: The clinician will gather information about the patient's symptoms, medical history, and conduct a physical examination of the skin.
2. Patch Testing: To identify specific types of allergies that may be causing or exacerbating the dermatitis, patch testing may be recommended.
3. Blood Tests: These may be conducted to check for other causes of the rash or to identify peripheral eosinophilia, which can support the diagnosis of AD.
4. Skin Biopsy: In some cases, a skin biopsy of the rash or lesion may be performed to rule out other skin diseases.
5. Allergy Testing: Although of limited value, allergy testing may sometimes be used to identify potential allergen triggers.

"Developing a basic skin care routine may help prevent eczema flares." - Mayo Clinic

Treatment Options

The treatment of atopic dermatitis may include:
1. Regular Moisturizing: This is often the first step in managing dry skin associated with AD.
2. Topical Medications: These may include medicated creams that control itching and help repair the skin, such as topical corticosteroids or calcineurin inhibitors.
3. Systemic Medications: For more severe cases, systemic medications such as oral corticosteroids, immunosuppressants, or biologic drugs may be prescribed.
4. Phototherapy: Treatment with ultraviolet light can be beneficial for some patients with AD.
5. Trigger Avoidance: Identifying and avoiding triggers that worsen AD is an important part of the management strategy.

Doctors and Specialists Likely To Be Involved In The Patient’s Care

• General Practitioner (GP): The GP can provide initial assessment and management of atopic dermatitis.
• Dermatologist: A specialist in skin conditions who can provide advanced diagnosis and treatment options for AD.
• Allergist/Immunologist: May be involved if allergies are suspected to play a role in the patient's AD.
• Paediatrician: For children with AD, a paediatrician will often be involved in their care, especially in managing the condition alongside other childhood illnesses.

Related Conditions or Complications

People with Atopic Dermatitis often have other conditions such as asthma, allergies, including food allergies, and other skin diseases like ichthyosis, which causes dry, thickened skin.

"People with atopic eczema usually have periods when symptoms are less noticeable, as well as periods when symptoms become more severe (flare-ups)." - NHS England

Outlook and Prognosis

With proper management and treatment, most people with Atopic Dermatitis can lead a normal life. However, the condition is chronic and can flare up periodically.

Practical Tips & Coping Strategies

• Keep the skin moisturised
• Avoid known triggers
• Use gentle, fragrance-free skin care products
• Wear soft, breathable clothing
• Keep nails short to prevent scratching