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Dr. Shreya Andric is a dermatologist based in Sydney. She is passionate about skin health and her mission is to educate the public on how to care for their skin, and also clear up the vast amount of misinformation out there on this topic.
While Dr. Andric has independently chosen the products that appear in this article, she does not receive revenue from the links. Some of the links may return revenue to Yahoo Lifestyle Australia.
Atopic dermatitis (AD), also called atopic eczema, is the most common inflammatory skin disease worldwide.
It affects up to 15% of people at any point in their life. It usually affects people who have an “atopic tendency”, that is those who have a background of hayfever, asthma and food allergies or a family history of the same. It affects all age groups and all races.
AD usually starts in infancy, affecting up to one in five children. Although it can settle in late childhood and adolescence, it is still found in 5-15% of young adults up to 26 years of age.
It’s a complex condition and a number of factors seem to be important for its development, including genetics as well as environmental factors. A tendency to atopic conditions tends to run in families.
There is a gene alteration that results in changes in affected people’s skin barrier, which therefore allows irritating substances and particles to enter the skin, causing itch and inflammation. Environmental factors include contact with soap, detergents and any other chemicals applied to the skin, exposure to allergens, and infections with bacteria and viruses.
Eczema can affect any part of the skin, including the face. The most frequently affected sites on the body include the creases of the elbow and knee joints, as well as the wrists and the neck.
The affected skin is usually dry and red. When it is very active, it may become moist and weep during a flare-up. Small fluid-filled blisters can develop when it affects the skin on the palms and soles. Skin that is repeatedly scratched may thicken (called lichenification) and this may cause the skin to itch more. As the skin is healing, it may become darker or lighter (post-inflammation hyper- or hypopigmentation). This can take many months to resolve.
Given how common eczema is, its features are usually easily recognised by GPs, paediatricians and dermatologists. For most patients, blood tests and biopsies are not required for diagnosis.
What can make AD flare?
Irritants such as soaps, detergents and other chemicals, heat, dust, woollen clothing and pets
Being unwell, for example having a common cold can cause AD to flare
Infections with bacteria or viruses. Secondary bacterial infection makes the affected skin yellow, crusty and inflamed, and often requires specific treatment. Infection with the cold sore virus (herpes simplex) can cause a sudden painful flare-up, which can be dangerous, depending on the area affected.
Dryness of the skin
Teething in babies
Food allergens can very rarely cause a flare
Can AD be cured?
Unfortunately, no. Atopic dermatitis is a chronic skin condition with no cure but it can be managed. We can hope that a child will grow out of it as they grow older (60% clear it by their teens), however, many of these people continue to have dry skin and will therefore benefit from lifelong avoidance of irritants, such as the ones mentioned above.
Can AD be prevented?
There is no clear proven way to prevent eczema. There are many theories out there, including that exclusive breast-feeding can prevent eczema in susceptible infants, however, there is no evidence supporting this. If your child has a tendency to eczema, it is good to get into a routine from birth whereby you use a soap-free wash and apply a moisturiser daily.
How do you treat AD?
It is important to keep in mind that eczema cannot be cured and to expect that it will flare from time to time. The mainstay of treatment is to optimise the skin barrier, avoid triggers, and to treat flares as soon as they develop.
The best ways to keep the skin hydrated is by having quick (3-5 minute), cool showers with a soap-free wash – and try to have only one shower per day if possible. You should then pat the skin dry and apply a moisturiser top to toe whilst the skin is still damp. My favourite moisturisers for eczema-prone patients include Dermeze Treatment Cream, QV cream, Aveeno Skin Relief Moisturising Cream and Avene XeraCalm AD Lipid Replenishing Balm.
Topical treatments are those that are applied to the skin. Topical steroids and ointments will usually improve the redness and itch of active AD. They come in different strengths and your doctor will advise which type needs to be used, where, and for how long. When used appropriately, topical steroids are very effective and safe to use. There are other topical preparations which are not steroid-based which can also be prescribed.
As the itch from AD is not histamine-driven, antihistamines tend not to be helpful in reducing inflammation in the skin, however, antihistamines that make people sleepy can be helpful when taken at night to reduce sleep disruption.
Some people with chronic eczema who are not responding to topical treatments benefit from light treatment. This is usually performed in a specialist hospital department or in a dermatologists’ private practice.
People with severe or widespread AD not responding to topical treatments may need tablet or injected treatments. These work by dampening down the immune system and are given under the close supervision of a dermatologist.
Can someone with AD lead a normal life?
Patients with AD can lead a full life including sports, swimming and travel. You many need to make small changes such as keeping moisturiser or other treatment with you at school, work, or when away from home.
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