Atopic Dermatitis is a very common, chronic skin disease that affects adults, children and babies. Skin on the face and body is very dry and irritable. Typically Atopic Dermatitis has two phases, active (also known as ‘flare-ups’ and inactive. It is important for sufferers to protect skin during inactive phases to prolong the periods between active phases.
Atopic Dermatitis (or Atopic Eczema) is a non-contagious chronic disease in which skin on the face and/or body is constantly dry, itchy and irritable. In other words, it is an inflammatory illness – and one that is becoming increasingly prevalent, particularly in the Western world. It affects 10% of the global population (between 10-20% of children and 2-5% of adults are affected) and, over the past 30 years, cases have grown by 200-300%.
Babies and small children are most commonly affected. 90% of patients experienced symptoms before the age of five and 80% before the age of two.
In young children and babies, the most commonly affected area of skin is the face although, as they get older, the rash may spread to the body. Facial Atopic Dermatitis affects all ages and usually appears as dry and scaly patches on the scalp, forehead, round the eyes and behind the ears. Outbreaks are also very common on the cheeks, particularly in babies.
Symptoms differ from person to person, from season to season, even from day to day. Sufferers describe two distinct phases in atopic skin – inactive („interval“) and acute (“flare-ups”).
In an acute flare-up sufferers experience: light to intense itching and skin that is red to deep red, flaky, uneven to swollen, sore and even mildly bleeding.
During a non flare-up phase, symptoms are dry to very dry, slightly flaky, irritable skin (a condition - not a disease - also known as Xerosis) and the affected area may have small, healed cracks.
As well as the problems caused by the skin irritation itself, Atopic Dermatitis can lead to further physical and psychological issues such as lack of sleep, discrimination, stress and a general lack of self-confidence – particularly in the case of facial Atopic Dermatitis. As a result, sufferers often restrict their daily lives by changing what they wear, what they eat, the make-up they choose and the activities they take part in. Relationships can even be affected if the sufferer feels his or her attractiveness is diminished by their symptoms.
You might have Atopic Dermatitis if…
If you are unsure about your symptoms seek the advice of a doctor or dermatologist.
There is no proven single cause for Atopic Dermatitis. Nor, sadly, is there a cure. However, avoidance of triggers and daily proactive intensive care can prolong the healthy phases of atopic skin while acute treatment offers quick relief and recovery from flare-up symptoms.
There are a number of genetic and environmental theories as to why some people develop Atopic Dermatitis and others don‘t. These include:
If both parents have Atopic Dermatitis, their child has an 60-80% chance of inheriting its parents’ disease.
There are four pathogenetic factors of Atopic Dermatitis:
1. Hereditary filaggrin deficiency; a deficiency of natural moisturising factors (NMF) such as amino acids.
2. Disturbed epidermal lipid metabilism (ceramides, cholesterol and free fatty acids) and impaired barrier lipid formation.
These lead to dry skin with a disturbed barrier function. This then makes it easy for infectious agents to penetrate:
3. Bacteria growth (Staphylococcus aureus) and the secretion of super-antigens.
4. Environmental influences such as irritants, allergens, pollution.
Dry, irritated skin results in inflammation and itchiness. Constant itchiness can lead to constant scratching. This disrupts the skin barrier, which results in a humid growth environment for bacteria. This, in turn, causes irritation and subsequent itching and inflammations. And so the Atopic Cycle continues (see illustration).
There are a number of other influences that can aggravate existing symptoms, although these vary from person to person. These include:
Read more about factors that influence skin.
Although there is no ‘cure’ for Atopic Dermatitis symptoms can be managed through consistent and regular care.
Emollients
Emollients (also called moisturisers) are key to this skincare and these should be used every day, regardless of whether the sufferer is in an active or inactive phase. These include lotions, face creams, ointments and bath/shower additives which oil the skin and help keep it supple, moist and protected from irritants. This also helps to prevent itch and may reduce the frequency of flare-ups.
The role of emollients is to prevent Atopic Dermatitis from flaring up. This is known as basic care.
With facial Atopic Dermatitis it is particularly important that moisturisers form part of the daily face care routine.
Key ingredients in emollients can include:
Dermatological treatments
Medicinal treatments, such as topical ointments (usually containing hydrocortisone), tackle the symptoms of flare-ups and help to reduce any inflammations and itching.
Corticosteroids are very effective and fast-acting and alleviate itching in cases of severe flare-up. However, it is not a long-term sustainable option as prolonged can have negative side effects. Also, it can’t be applied on large skin areas and it loses efficacy with continuous use.
Daily personal care for facial Atopic Dermatitis
If you are unsure which management route to take please seek the advice of a doctor or dermatologist.
