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Atopic dermatitis (AD)

1. What is Atopic dermatitis?

It consists of severely itchy, skin rash generally seen in young children & adolescents, which may be recurrent or may last for longtime.

It is a common disease in developed countries, around 10-20% children suffer from AD. In India, exact prevalence is not known, but it is supposed to be low.

2. What are the factors causing Atopic Dermatitis?

A. Genetic: AD is more likely to develop if one or more parents have the disease or history of allergic tendencies (Atopy)

B. Environmental:

• Pollution

• Excessive cold climate

• Heat and exercise induced sweating

C. Altered Immunity: alterations in immune system (protective system which fights with disease pathogens) has been given as major factor

D. Defective barrier function of skin leading to excessive loss of water ?

E. Dietary factors

3. Which diseases are associated with it?

It is commonly associated with other allergic diseases like,

• Eczema

• Asthma

• Hay fever

4. What are the Symptoms of AD?

• It generally starts between 2-6 months of age, but can manifest in any age group

• Children generally have dry scaly, itchy, red patches over face. Once child begins to crawl, these patches are seen over exposed parts of hands & legs

• In older children & adolescents, patches are mainly seen on inner aspect of hands and feet

• Many times there is

• discharge from patches due to presence of bacterial infection

• thickness of skin due to constant scratching /rubbing

1. Creams to be applied on pimples/affected area

2. Tablets mainly mild antibiotics , isotretinoin etc

3. Chemical peels

4. Lasers like IPL

5. What are the Factors worsening AD?

a. Woolen clothing

b. Stress

c. Excessive Heat & sweating

d. Skin irritants: perfumes, soaps

e. Habitual scratching

f. Dryness of skin

g. Skin infections

h. Food allergens- include cow''s milk, beef, eggs, chicken, fish, wheat, citrus & berry fruits, food additives, chocolates, nuts

i. Airborne allergens

6. What general care should be taken by for the patient of A.D.?

• Avoidance of worsening factors: It forms most important part of disease management. With time parents tend to recognize the triggers of disease flare & simply avoiding them can help a lot.

• Proper skin care which includes

I. Take bath with lukewarm water & mild skin cleanser

II. Air-dry or pat dry your body

III. Apply ample amount emollient cream all over body

IV. Early detection of fissures, scratches & oozing lesions

7. How A.D. can be treated?

a. Anti allergic/anti-itch tablets(Antihistamines) to decrease itching & irritation, especially sedative agents at night so that that child has sound sleep

b. Judicious use of low strength steroid creams for a short time. depending upon severity, sites & age of patients

c. Antibiotics in presence of oozing & discharge

d. Creams containing Calcineurin inhibitors

e. Phototherapy in the form of Narrow Band Ultraviolet B rays(NB-UVB) is very useful tool in control of extensive disease

f. In case of severe disease, certain oral medications (immunosuppressive agents) are also required