Through our unique affiliation with the University of Colorado School of Medicine, Department of Dermatology, we can offer our patients expanded treatment options which continues our commitment to provide the most comprehensive and up to date dermatologic care possible for our patients.
Atopic dermatitis (AD) is a chronic skin disorder that causes dry, itching, and inflamed skin. The rash of atopic dermatitis comes and goes. The term eczema is sometimes used to describe atopic dermatitis. Eczema refers to inflamed, itching skin from a variety of causes. Atopic dermatitis is the most common type of eczema.
What Are The Symptoms Of Atopic Dermatitis?
The most obvious symptoms of atopic dermatitis are intense itching, along with red, dry skin that is sometimes scaly. The worsening of atopic dermatitis symptoms is referred to as a “flare”. An atopic dermatitis flare can be triggered by a variety of factors (see below). The appearance of atopic dermatitis varies tremendously from person to person. Most people with atopic dermatitis experience a short-term flare for a few weeks (acute), during which the skin looks red, raised, and cracked. Between flares, the skin may appear normal or slightly dry. If the rash lasts a long time (chronic), the skin may start to change appearance, becoming thicker and darker. These patches of thickened skin take longer to respond to treatment. The appearance of atopic dermatitis also tends to vary depending on the age of the person.
What Triggers Atopic Dermatitis?
Not everyone with atopic dermatitis will have the same triggers, so people with the disorder will have to keep track of their particular sensitivities. Because identifying triggers can be tricky (for example, sometimes there is a delay between eating a certain food and seeing a resulting flare-up), it’s a good idea to keep a journal of any atopic dermatitis symptoms and possible causes. Some commonly reported atopic dermatitis triggers include:
Irritants—These are substances that contact the skin directly, causing redness and inflammation. They include wool or other synthetic fabrics, soaps and detergents, perfumes and makeup, cigarette smoke, and chemicals (such as chlorine).
Allergens—Allergens are more indirect triggers, where the skin becomes inflamed and itchy because of an allergic reaction, such as from pollen, mold, or animal and pet dander.
Stress—While stress isn’t a known cause of atopic dermatitis, it can aggravate flare-ups.
Temperature—Many people with atopic dermatitis have chronically dry skin that is sensitive to certain climate conditions, such as cold winter weather, indoor heating, or warm baths. Humid environments, such as a sauna, may cause sweating that could trigger a flare-up.
Between 20-25% of people worldwide develop atopic dermatitis. This is a term that is sometimes used interchangeably with eczema to describe skin conditions characterized by irritated, inflamed, itchy patches of skin. People who have atopic dermatitis have long lasting symptoms and often have a history of allergies, asthma and one or more family members who have experienced atopic dermatitis. In some people atopic dermatitis may cause the skin to appear very red with a rash that seems to bubble up and in others it can appear scaly, flaky and dry with less discoloration. Atopic dermatitis is not contagious and is believed to results from genetic factors that influence the function of the skin causing it to be extra sensitive to irritants. Your skin is composed of 2 main regions, the dermis and epidermis. The Epidermis is the outer layer that acts as your body’s primary defense against the environment. It keeps out germs and allergens, which are substances to which the body produces an allergic response. The Dermis lies beneath the epidermis and is responsible for providing structure and support to the skin. On most of the body, the epidermis is actually comprised of 4 distinct layers as shown. Cells that are produced in the stratum basale are pushed outward as new cells develop and they gradually die off as they migrate to the stratum corneum where they eventually sluff off. Normally the rate of skin production and loss are equal so that the thickness of this outer layer remains constant. However, in some instances more skin cells may be shed from the stratum corneum than accumulate or excessive skin cells may accumulate as abnormally thickened skin. Atopic dermatitis is believed to result from how a person’s genes influence their immune response and formation of the epidermis. Researchers don’t know the exact cause but there are 2 primary theories. In one theory it is believed that genetic factors influence the immune system in the skin to cause the skin to react as if there has been contact with an allergen. A series of internal reactions cause itchiness and inflammation that damages the skin’s barrier layer. The damage results in increased water loss through the epidermis resulting in dry patches and further degradation. Allergens and germs may enter the eroded skin, setting off more reactions. In another theory it is believed that a person’s genes cause the outer layer of skin to be abnormal and ineffective as a barrier. Excessive water is lost through the skin causing dryness and a breakdown of the outer layer allowing allergens to penetrate. Starting a cycle of itchiness and inflammation that further erodes the skin. The majority of patients with atopic dermatitis have regions that are constantly itchy even when there are no other symptoms. When inflammation develops from atopic dermatitis it irritates patches of skin causing them to redden and become so itchy that it is hard to resist scratching. Regions of elevated fluid filled bumps may potentially develop with continued irritation these bumps may burst and exude pus and become crusty or the skin may become dry and cracked. Although, atopic dermatitis is not associated with life threatening risks, if scratching the itch causes openings in the skin that penetrate into the dermis, germs may enter and cause a secondary infection. In some people, the skin responds to continued long term scratching of itchy areas by producing an excessively thick outer layer. This process which is called lichenification, results in the skin having a leathery cracked appearance. When does Atopic Dermatitis usually occur? The majority of cases of atopic dermatitis begin during the first year of life and about 90% of cases first occur before age 5. Although it is rare, atopic dermatitis can also first occur at the onset of puberty or later during adulthood. Active atopic dermatitis can disappear entirely or it may enter a period of remission and recur as a flare up at some point in the future. Half of the atopic dermatitis cases infants clear by 1.5-2 years of age. While others take longer or may never completely disappear. A person may continue to exhibit signs into adulthood. Primarily on the hands and symptoms elsewhere can recur periodically at any age. In infants, atopic dermatitis typically appears on the scalp, forehead, cheeks, neck, forearms and legs. In contrast, children and adults most commonly experience patches of atopic dermatitis occurs on the face, neck, upper chest, elbow creases, wrists, hands, fingers, back of the knees, ankles and feet. Although there and tendencies, atopic dermatitis can occur on any part of the body at any age. It may be triggered by a variety irritants that vary from person to person. Triggers and Irritants of Atopic Dermatitis These irritants include: dry skin, sudden temp changes, abrasive fabrics, certain chemicals and smoke, various food items, substances from living organisms and environmental factors such as stress, low humidity, long baths and lack of skin moisture. Sometimes triggers can be identified with skin allergy tests but often they are difficult to determine and are only identified after observing changes in someone’s diet or the products one uses and how symptoms worsen or improve over time. How to manage living with Atopic Dermatitis There is no cure for atopic dermatitis but it can often be managed with treatment, avoiding triggers and taking preventative actions like keeping fingernails short, resisting the urge to scratch can also prevent making conditions worse. Sleeping in hand mitts may help children who find it difficult to resist scratching. Bathing in lukewarm water and using special soaps. Applying moisturizers directly after bathing are also often effective to clearing up symptoms. New products that are designed to limit water loss and improve the structure of the skin barrier are also effective in many patients. Although not always necessary, the primary medications used for treating atopic dermatitis include moisturizers to reduce dryness. Corticosteroids to help reduce swelling and itchiness. Immune Modulators which suppress skins immune response. Antihistamines that also reduce itchiness. Fortunately childhood onset of atopic dermatitis will usually naturally resolve over time. In people with persistent or recurring symptoms available treatment options can help control atopic dermatitis. Consulting a health care provider can help you identify triggers and manage your symptoms of flare ups and find the best treatment options for your particular skin. Although there is no cure, symptoms can usually be managed well enough for patients to lead a comfortable and productive life.