Atopic dermatitis

Signs and symptoms

Itch is the central symptom — it is the one that bothers the most and that guides the itching behaviour, which aggravates the lesions. The most common manifestations are:

• Generalized dry skin (xerosis).
• Eczemas — red, peeling plates, sometimes with small gallbladders.
• Intense itch, often worse at night.
• Typical locations — bends (kilts, knees), face, neck, hands.
• Skin thickening in chronically scratched areas (lichenification).
• Painful fissures in flexion zones or fingers.
• Sleep disturbed in the most intense outbreaks.

How it presents itself at different stages of life

The typical location and appearance vary with age, although the central symptoms are the same:

• Infant (0-2 years) — face, scalp and extensor surfaces of the limbs; frequent exudative lesions.
• Child (2-12 years) — elbow bends, knees, wrists, ankles; drier and thicker lesions.
• Adolescent and adult — folds, face, neck and hands; predominance of thickening, very dry skin and chronic itching.

Causes

Atopic dermatitis results from the combination of several factors that weaken the skin barrier and alter the immune response:

• Genetic predisposition — mutations affecting skin barrier proteins (e.g. filagrine).
• Skin barrier dysfunction — the skin loses more water and is more permeable to irritants and allergens.
• Altered immune response, with exaggerated inflammation to usually harmless stimuli.
• Personal or family history of atopy (asthma, allergic rhinitis, food allergies).

Frequent triggers

Outbreaks can be triggered by factors that vary between people. Identifying your triggers is essential to reduce the frequency of crises:

• Dry air and cold temperatures.
• Excessive sweat and heat.
• Aggressive soaps and detergents.
• Clothes of wool or synthetic fabrics that sting.
• Environmental allergens (dust mites, animal hair, pollens).
• Emotional Stress.
• Skin infections — skin with atopic dermatitis is more easily infected.

Diagnosis

The diagnosis is clinical, made by the evaluation of injuries, distribution and personal and family history of atopy. No routine tests required.

In an online consultation, the dermatologist analyzes photographs of the affected areas and a questionnaire on the evolution, triggers and treatments already used. With this information it evaluates gravity and defines a custom plan.

In cases with strong suspicion of allergy to specific allergens, a complementary allergological investigation may be recommended.

Options for treatment

Treatment of atopic dermatitis has two axes: basic care (every day) and control of outbreaks (when they appear).

Daily Care Making a Difference

Much of the control depends on simple habits, applied consistently:

• Moisturize the skin generously every day, even out of outbreaks.
• Quick baths (5-10 min), with warm water, not hot.
• Replace traditional soap with soft product without soap.
• Dry the skin with towel in soft touches without rubbing.
• Apply the emollient in the first minutes after the bath.
• Avoid clothes that pinch or pinch; prefer cotton.
• Keep your nails short to reduce scratch injuries.

Frequently asked questions