Atopic Dermatitis (Atopic Eczema)
Atopic dermatitis is a common chronic skin disease, particularly in children under the age of 5. Key symptoms include intense itching, dry skin, inflammation, and periodic flare-ups.
Patients often have concurrent allergic conditions such as asthma, allergic rhinitis, or food allergies. While the exact cause is not fully understood, it is believed to involve genetics triggered by environmental factors.
Factors that trigger flare-ups include weather changes, contact with skin irritants, and bodily infections. The prevalence of this disease among Thai children aged 6-7 years in Bangkok is 16.7%, while for those aged 13-14 years, it is 9.6%. Symptoms generally improve as the patient gets older.
Symptoms of Atopic Dermatitis
The primary symptoms are itching, red rashes, and dry, scaly skin. Usually, there are no blisters, but the area can become easily infected and turn into pustules or ooze fluid. Common areas include the face, cheeks, neck, and skin folds. In children, rashes often appear on the head and face, while in adults, they typically occur on the elbows, knees, neck, hands, and feet.
Key Clinical Features
- Skin itching (Pruritus)
- Chronic or relapsing rashes
- Family history of atopy/allergies
- Distribution of rashes typical for Atopic Dermatitis
Associated Features often found with Atopic Dermatitis
- Ocular features: Cataracts, keratoconus, or dark circles under the eyes
- Facial pallor
- Dry skin (Xerosis)
- Skin flushing/redness
- Pityriasis alba (white patches on the face)
- Prurigo nodules (itchy bumps)
- High susceptibility to skin infections
- Food allergies
Diagnostic Tests to Identify Triggers
- Skin allergy testing, such as the Skin Prick Test or Patch Test.
- Food allergy testing, especially in young children with severe symptoms.
- Blood tests to detect specific allergen sensitivities (Specific IgE).
Treatment of Atopic Dermatitis
- Avoid known allergens and triggers.
- Avoid wearing rough fabrics like wool or synthetic fibers; cotton is recommended.
- Avoid extremely hot environments.
- Avoid scratching or coming into contact with irritants.
- Do not bathe for too long; use water that is neither too hot nor too cold.
- After bathing, pat the skin damp and apply moisturizer within 3 minutes. Regular moisturizing significantly reduces the need for topical steroids.
- If an itchy rash is present, apply prescribed medication to the rash before applying moisturizer.
Disease Progression
Symptoms begin in infancy for 85% of cases, with 17% starting within the first 5 years of life. Flare-ups occur periodically until about age 7. Approximately 20% of patients continue to have chronic symptoms into adulthood, while only 16.8% of patients first develop the condition as adults.
A comprehensive treatment plan, prevention of flare-ups, and maintaining remission for as long as possible until the disease subsides—along with close monitoring by a physician—will greatly improve the effectiveness of care.
