Atopic dermatitis
Atopic dermatitis: Excerpt from Professional Guide to Diseases (Eighth Edition)
Atopic dermatitis is a chronic skin disorder that’s characterized by superficial skin inflammation and intense itching. Although this disorder may appear at any age, it typically begins during infancy or early childhood. It may then subside spontaneously, followed by exacerbations in late childhood, adolescence, or early adulthood. Atopic dermatitis affects less than 1% of the population.
Causes
The cause of atopic dermatitis is still unknown. However, several theories attempt to explain its pathogenesis. One theory suggests an underlying metabolically or biochemically induced skin disorder that’s genetically linked to elevated serum immunoglobulin (Ig) E levels. Another theory suggests defective T-cell function.
Exacerbating factors of atopic dermatitis include irritants, infections (commonly caused by Staphylococcus aureus), and some allergens. Although no reliable link exists between atopic dermatitis and exposure to inhalant allergens (such as house dust and animal dander), exposure to food allergens (such as soybeans, fish, or nuts) may coincide with flare-ups of atopic dermatitis.
Signs and symptoms
Scratching the skin causes vasoconstriction and intensifies pruritus, resulting in erythematous, weeping lesions. Eventually, the lesions become scaly and lichenified. Usually, they’re located in areas of flexion and extension, such as the neck, antecubital fossa, popliteal folds, and behind the ears. Patients with atopic dermatitis are prone to unusually severe viral infections, bacterial and fungal skin infections, ocular complications, and allergic contact dermatitis.
Diagnosis
Typically, the patient has a history of atopy, such as asthma, hay fever, or urticaria; his family may have a similar history. Laboratory tests reveal eosinophilia and elevated serum IgE levels. A skin biopsy may be performed, but it isn’t always required to make the diagnosis.
Treatment
Measures to ease this chronic disorder include meticulous skin care, environmental control of offending allergens, and drug therapy. Because dry skin aggravates itching, frequent application of nonirritating topical lubricants is important, especially after bathing or showering. Minimizing exposure to allergens and irritants, such as wools and harsh detergents, also helps control symptoms.
Drug therapy involves corticosteroids and antipruritics. Active dermatitis responds well to topical corticosteroids, which should be applied immediately after bathing for optimal penetration. Oral antihistamines are commonly used to help control itching. A bedtime dose may reduce involuntary scratching during sleep. If secondary infection develops, antibiotics are necessary. A newer treatment is the use of topical immunomodulators; these agents are steroid-free and have demonstrated an 80% success rate in studies.
Special considerations
❑ Monitor the patient’s compliance with drug therapy.
❑ Teach the patient when and how to apply topical corticosteroids.
❑ Emphasize the importance of regular personal hygiene using only water with little soap.
❑ Be alert for signs and symptoms of secondary infection; teach the patient how to recognize them as well.
❑ If the patient’s diet is modified to exclude food allergens, monitor his nutritional status.
❑ Offer support to help the patient and his family cope with this chronic disorder.
❑ Discourage use of laundry additives.
❑ Dissuade the patient from scratching during urticaria to help prevent an infection.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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