ATOPIC DERMATITIS

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Definition

Atopic dermatitis is a chronic inflammatory skin disease characterized by dry skin, intense itching, and eczematous lesions, with a relapsing-remitting course (phases of flare-ups and remissions). It is a non-contagious condition and is often associated with other atopic diseases such as asthma and allergic rhinitis.

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Epidemiology

• Affects about 10–20% of children and 1–3% of adults.

• Often appears in the first years of life (usually before age 5).

• In many cases, it improves or resolves with age.

• More common in industrialized countries.

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Pathology (Mechanism)

• Dysfunction of the skin barrier → water loss and increased penetration of allergens, irritants, and microbes.

• Exaggerated immune response to external stimuli.

• Chronic inflammation and skin dysfunction with a predominance of Th2 immune cells.

• Genetic predisposition (e.g. filaggrin gene mutation, essential for skin barrier integrity).

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Causes and Risk Factors

• Genetic factors (family history of eczema or allergies)

• Environmental factors: pollution, harsh detergents, allergens (dust mites, pollen)

• Stress and sleep disorders

• Dry skin (xerosis)

• Cold or excessively dry climates

• Food allergens (in some cases)

Diagnosis

• Mainly clinical, based on:

• Appearance of lesions

• Chronic itching

• Personal/family history of allergies

• Diagnostic criteria (e.g., Hanifin and Rajka criteria)

• Additional tests (optional):

• Allergy testing (Skin Prick Test, specific IgE)

• Skin swab if infection is suspected

• Skin biopsy (rarely needed)

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Treatment

• Daily skin hydration with emollients (creams, ointments, oils)

• Topical corticosteroids (during flare-ups) to reduce inflammation

• Topical calcineurin inhibitors (e.g. tacrolimus) as steroid alternatives

• Oral antihistamines for itching (especially at night)

• Antibiotics if secondary skin infection is present

• In severe or resistant cases:

• Phototherapy (UVB)

• Systemic immunosuppressants: cyclosporine, methotrexate

• Biological therapies: dupilumab (monoclonal antibody)

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Nursing Care

• Assess and monitor the skin: location, extent, signs of infection

• Patient and family education:

• Proper medication application

• Consistent use of moisturizers

• Avoid scratching

• Psychological support to manage pruritus and frustration

• Monitor treatment response

• Maintain a clean and allergen-reduced environment

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Advice and Prevention

• Avoid hot and prolonged baths; take short showers with mild cleansers

• Apply moisturizers immediately after bathing

• Wear cotton clothing; avoid wool and synthetic fabrics

• Keep nails short to reduce scratching damage

• Use a humidifier if the air is dry

• Avoid excessive sweating and temperature extremes

• Identify and reduce exposure to triggers or allergens

• Educate the family on the importance of ongoing treatment, even during symptom-free periods.