‘Eczema’ is an umbrella term for polymorphic, pruritic skin conditions caused by a non-infectious inflammation of the skin. It is caused by intrinsic and / or environmental factors. ‘Atopic dermatitis (eczema)’ is a type of eczema with skin abnormalities in characteristic, age-dependent locations and an atopic
constitution. A characteristic feature of atopic eczema is an innately disturbed barrier function of the skin caused by genetic defects in the protein filaggrin, resulting in dry skin. The atopic constitution involves the predisposition to develop IgE mediated conditions, such as eczema, asthma and allergic rhinitis
and is often accompanied by elevated levels of immunoglobulin E (IgE).
Dry skin and an intense itch are the most prominent signs of atopic dermatitis. Presentation varies largely and depends on the patient’s age, ethnicity and disease activity. Characteristic acute lesions are erythematous papules and (mainly in young children) vesicles with exudation and crusting. Longer existing lesions present as dry, scaly or excoriated papules and (mainly in adults) as skin thickening from chronic scratching (lichenification).
In young children, atopic dermatitis typically presents on the extensor side of arms and legs and cheeks or scalp. In older children, adolescents and adults, plaques present more typically on the flexor surfaces (e.g. in knees, elbows, wrists) and they are more localised in adults.
Atopic dermatitis occurs mainly in children, with the very youngest (under one year of age) most commonly affected. Generally, atopic dermatitis presents before the age of five, and most affected children (80%) are free of symptoms by the age of 15. In underfive age groups, atopic dermatitis is by far the most common type of eczema.
Atopic dermatitis is a chronic skin disease, in which symptom-free periods often alternate with exacerbations. Factors that may aggravate the condition are transpiration, warm or cold temperatures, rough textile fibres (e.g. wool), illness, stress, soap, shampoo and cleaning products.
The diagnosis is made clinically, based on the history, appearance and distribution of skin lesions taking the patient’s age into account. Additional investigation is rarely needed but may be helpful when contact / allergic dermatitis or a food allergy are suspected.
Scratching aggravates dermatitis and should be avoided. Nails are best kept short. Bathing should be short, using lukewarm water and non-frequent. The use of emollients to increase the hydration of the skin and to reduce itch and irritation is the basis of the treatment, even when skin eruptions are minimal or absent. The personal preference of the patient or their parents is important in choosing which type of emollient to use. In addition, corticosteroids for topical use are often needed. They suppress the inflammation and reduce itching. Topical corticosteroids are categorised in four classes and the class of corticosteroid prescribed depends on the severity of the eczema, its effect, and the frequency of exacerbations. For moderate eczema, class i is advised, which can be replaced by class ii if the effects are insufficient. Class iii is advised for severe atopic dermatitis. Patients should be informed about how to apply creams or ointments. Referral to the dermatologist is appropriate if the response to treatment is insufficient or when the use of corticosteroids cannot be phased out.