Atopic dermatitis

What is atopic dermatitis and how common is it?

Atopic dermatitis is the most common chronic inflammatory skin disease in children. 15-20 % of child population suffers from this condition. The disease is characterized by inflammatory skin changes, dry and itchy skin. Worsening of the condition after the quiet period is frequent. In 60% of children onset in early infancy is typical, with first symptoms appearing within first age and 85% of children are diagnosed until fifth year of life. It is important to note that there is a hereditary tendency for the disease, which is transmitted in the family.

What is atopy?

Atopy is an inherited predisposition for allergic reactions to various environmental and nutritional allergens that is characterized with high levels of IgE antibodies. Atopic disease includes atopic dermatitis, allergic asthma, allergic rhinitis and food allergies. Atopic dermatitis is the most common disease in the so-called ‘atopic march’ along the way with manifestation of other atopic diseases. There is a risk of 40-50% that a child with severe form of atopic dermatitis will eventually suffer of bronchial asthma and 70% risk of developing allergic rhinitis.

What is the cause of atopic dermatitis?

The cause of atopic dermatitis is a very complex issue and bias for developing the disease is only partially understood. There is a strong genetic predisposition for disease and along with hereditary immune imbalance a genetic basis for disturbed epidermal skin barrier in form of mutation of protein that is crucial for the development of protective skin barrier. Because of this disorder atopic skin have less qualitative and non-functional protective barrier which makes it dry, easily loses the water and is permeable for allergens and micro-organisms in the deeper layers of the skin, altogether increasing the risk of developing allergic reactions.

Can atopic dermatitis be prevented?

Correlation between exposure to allergens, environmental occurrence of sensitization and the occurrence of relevant symptoms is complex and is subject of numerous studies. Avoiding exposure to allergens to which the child is sensitized is crucial for prevention of all allergic diseases including atopic dermatitis. Early sensitization to allergens in the environment, primarily to allergens such as dust mites and tobacco smoke are important risk factors for asthma and allergic rhinitis but also for worsening of atopic dermatitis in infancy. Therefore, it is recommended to reduce the concentration of dust mites in the area where the child resides and avoid exposing the children to cigarette smoke. In children with known food allergy a full elimination diet is recommended which often improves the condition.

How common is food allergy in atopic dermatitis?

Food allergy occurs in 30-50% children with atopic dermatitis, and risk is higher with disease occurred earlier and with more severe clinical presentation. Most common food allergens are cow’s milk, eggs, soy, wheat flour, peanuts and fish. Hypersensitivity to food allergens usually vanish between 3rd-5th year of life and it depends on the severity of allergic reactions and consistency in the implementation of the elimination diet. This rule does not apply to all food allergens in way that sensitivity to peanuts, shellfish usually stays lifelong issue.

Allergy testing

If the doctor suspects in allergic reaction allergy testing should be done. It was believed that in children under three years of age allergy testing are irrelevant. It is now known that even infants can demonstrate skin sensitivity to different food allergens in testing and that there is no justified need for delaying the testing.

Important note: antihistamines should not be taken for at least 7 days before the testing, because medications can affect (anulate) test results.

What is the treatment of atopic dermatitis?

In the treatment of atopic dermatitis a daily skincare with neutral emolient creams and application of therapeutic oil baths is extremely important for recovering the skin barrier. Usage of neutral emolient creams will reduce the appearance of inflammatory skin changes, as well as the need for corticosteroids. It will also reduce the itching of the skin and reduce the skin permeability to allergens of the environment. However, corticosteroids remain the standard therapy for atopic dermatitis especially when inflammatory changes are present, having in mind that the amount and intensity of corticosteroid preparation, as well as the length of using corticosteroid medication must be well controlled.

Does the disease affect the quality of life of children and family?

The early onset and chronic nature of atopic dermatitis is a particular burden for the whole family and it can lower the overall quality of life of the whole family. It is known that atopic dermatitis in children can significantly damage self-esteem and thus the quality of child’s life. Because of sense of diversity children suffering from atopic dermatitis often go through reduced socialization with peers. They also often suffer from lack of sleep due to waking up during the night because of skin itching, which leads to fatigue, changes in mood, irritability and psychosocial dysfunctioning. Family relationships can be disrupted due to the complexity of skin care, cost of treatment and parent’s fatigue due to child’s awakening through the night.

What is the importance of education of parents in controlling atopic dermatitis in children?

Failure in the treatment of atopic dermatitis can be directly linked to inadequate implementation of therapy as a result of lack of understanding the disease and the basic principles of treatment. Interdisciplinary educational program, which includes pediatric dermatologist, pulmonologists, gastroenterologists, psychologists, nutritionists and specialized nurses, has become indispensable standard for controlling the disease and improving the quality of patients everyday life and whole family. The purpose of training programs is to provide clear information about the disease and educating patients and their parents to take control of the treatment of the disease.

Our experience with educational program for parents in the “Atopy school”

The educational program for parents of children suffering from atopic dermatitis in Croatia began in 2011 in Clinical Hospital Centre “Sestre Milosrdnice”, Department of Dermatology and venereology. Program was organized and carried through by dr. Lena Kotrulja, MD, PHD, dermatovenerologist, subspecialist in pediatric dermatology. The importance of this program was to enhance the parents awareness about the causes and pathogenesis of atopic dermatitis, factors that aggravate the inflammation, implementation of proper therapy, as well as the importance of maintaining the functional epidermal barrier.