Understanding atopic dermatitis

Note: this article still needs some review, I will be updating it many times so please if you are interested please check back later. If you find any errors that can be corrected or you want to suggest improvements write it on the comments. Thanks!

Abstract: In order to ‘cure’ this kind of illness it is very necessary to understand the roots and background of the subject, I personally have witnessed the benefits of treating an illness after understood what does it exactly do, affect, work etc. The doctor is basically an assistant, he works with many patients with different symptoms so it is not easy for him to make the accurate decision for you, so that is why you should not rely entirely on him, the patient is the one who has the personal experience of having the illness so the best doctor for the patient is the patient himself. All in all, before you get frustrated with your illness be sure you have understood it and taken the appropriate measures to eradicate it.

There are many types of skin diseases, but the most worrying is the dermatitis. Dermatitis causes skin disorders that are very noticeable and easily spotted and thus very unpleasant to have in our appearance. There are different types of dermatitis: seborreheic dermatitis (dark spots), stasis dermatitis, nummular dermatitis (these last two more common in elderly people), localized dermatitis (less acute, periodical) etc, here I am going to refer to one of the most chronic and long-lasting skin disease: atopic dermatitis.
Atopic dermatitis or atopic eczema as the name infers, is a type of non-normal skin disorder, that means it is out of the usual dermatitis pattern and its causes and symptoms are really hard to define. It was firstly discovered at the end of the c. XIX named neurodermatitis so it was determined that the causes of such disease had psychological origins. It has developed exponentially in the last 50 years, being more common in large developed countries. In the US it is the most common skin disease affecting 10 – 15% of the population to a 30% in children. Most sufferers have history of hay fever, asthma, dermatitis or/and have relatives with such problems. Atopic dermatitis that appears in children may disappear after puberty but it may also remain to adulthood.

Theories about the causes

Most cases of adulthood atopic dermatitis (AD) are incurable. It means that the sufferer carries the disease his entire life but it can be soften through delicate care and medical treatment. However, the key to improvements is to determine the triggers and control it. There are many theories about the causes of AD.

• Genetic theory attempts an explanation through human heredity. It states that 50% – 70% AD patients have medical history of hay fever, asthma or other dermatitis, or they have relatives that do. Also rhinitis and conjunctivitis can be sources of AD. Children with at least one parent with AD have a 60% chance to developed the disease. If  both parents have AD the chance may raise to a 80% probability of acquiring it. The origin is not exactly determined but it is suspected that a genetic disorder in the proteins of the atopic monocyte membrane (in the cells) is the root of the problem, though reasearch is still on progress.
• Immunological theory is the most complex one, since it uses the cells in the skin as a foundation to explain the skin disease. There are many not confirmed and complex theories, they basically claim incapacity of the skin to heal, the production of inflammatory substances and hypersensitivity as the main causes.
• Allergens theory is present in many AD cases currently but it is not confirmed that it is absolutely the cause. It primarily refers to those people who had historical allergic problems originated by a disorder in the cells generating too many IgE’s and other antibodies caused by allergies. AD then is caused by allergies the patient or any relatives had before, those can be medical history of conjunctivitis, rhinitis, food allergies, allergies from the environment (temperatures, climates…).
• Infective theory points S. Aureus bacteria as a trigger to AD. S. Aureus infiltrates into the skin causing skin disorders that may derive into a range of illness such celullitis folliculitis, impetigo, pimples, carbuncles and other skin infections. As for AD, it may increase the presence of pruritus maintaining or worsen the severity of the disease.
• Neurovegetative theory suggests that an abnormal nervous system response causes slow intradermic injection of histamine. This is especially evident in AD during changes of temperature where the skin can become extremely dry.
• Psychological/emotional theory associates the character of the person to AD. Edginess, aggressiveness, sensibility, agitation, sleeping disturbances, and other upsetting events are usually typical characteristics of AD flare ups.

These are the most remarkable theories of causes for AD, though in real cases, AD causes may be a mixture of all them mostly used as a reference purposes more than direct judgments.

Current atopic dermatitis issue

The research now a days tells us that there is a common practice in AD patients, the itching-scratching cycle. AD sufferers have itch because of many reasons, contact with allergens, dry skin, fragile immune system of the skin or other environmental factors. Those are usually called triggers. These triggers are the cause of itch but the problems come after that. Once the skin is scratched it becomes vulnerable to bacteria which infiltrates into the skin and can provoke other infections. Many times, such crack in the skin increase the itch making it more itchy, for that reason this type of skin is more vulnerable to other infections than a normal skin. The final result is usually the appearance of rashes all over the body especially in areas such eyelids, neck, hands, wrists as well as creases of elbows, knees and usually in children the cheeks, chin, back, stomach, and arms.

AD also has recurrent periods. There are periods with less eczema and periods with flare ups as well as development into other infections, areas or symptoms with time.

The most frequent method provided by doctors to control the eczema are oinments like corticosteroids and tacrolimus. Corticosteroids ointments reduce the itch by reducing the inflammation of the skin. Oinments with tacrolimus or pimecrolimus are drugs which modulate the immune system of the skin. Other may include antihistamines to reduce allergies that produce the itch. These treatments are very case-specific so they should be used moderately and never for a long period of time.

Aside, the key to rash-free skin is probably the daily care. Petroleum jelly, vegetable oil or even commercial moisturizers are good for daily skin care since AD skin is often dry and it should be kept moist to prevent further scratching.  Avoiding triggers, such as known allergens also make sense.

Other complementary treatments may be photo-therapy though they have their risks (skin cancer, cataracts) and it is not recommended for children.

In the long-run, continuous scratching makes the skin thick losing flexibility.

Conclusion

Atopic dermatitis is a chronic disease and it must be treated carefully. Origins, causes, effects of this illness are still not defined, research is still in progress. There is much work to do. Even though it seems that other illnesses such viral illnesses are taken with a greater importance skin diseases are not forgotten and there is still a bunch of good researchers out there working for a better knowledge and even a cure to make human lives better and suffering lesser.

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