Atopic Dermatitis in Little Children (Atopic Eczema)

Atopic Dermatitis in Little Children (Atopic Eczema)

  Autor Adina Hrincu Data: 19.02.2009

Atopic Dermatitis in Little Children (Atopic Eczema)
What is the atopy? 

The atopy is a genetic predisposition of an individual to develop one or more allergies such as: asthma, rash and atopic dermatitis, allergic conjunctivitis and rhinitis. 

What is atopic dermatitis? 

Atopic dermatitis is chronic pruritic dermatitis, it is familial and occurs in little children, often associated with allergic rhinitis and asthma. Same as asthma or allergic rhinitis, atopic dermatitis is characterized by local infiltration of T cells. More than a half of the patients with atopic dermatitis develop asthma or allergic rhinitis in time. Atopic dermatitis is a chronic inflammatory skin condition. Atopic dermatitis is developing for several years, with periods when it subsides completely (the child has no eczema lesions on the skin), or partially (with reduced lesions) interrupted by periodic flares. 
It affects 10-20% of the population and has had an increasing tendency during the latest decades. This skin condition is most frequent in children. One out of five babies suffers from this skin condition. Some will get rid of the troubles of this disease with time, while others will deal with it for a lifetime. The causes of this increase are not known. In 60% of the cases, the atopic dermatitis display symptoms before the age of one, and the symptoms improve in half cases after puberty; they last for a lifetime in few cases. 

Causes 

Each patient is different. The causes of atopic dermatitis are not known completely, but the increasing number of cases in the last few years made the disease be considered as caused by both environmental and genetic agents. 

Genetic factors 
If one parent has an atopic background, the risk for the children to inherit the sensitivity is high. Therefore, the familial incidence being high, the genetic factors are also implied. 

Environmental factors 
The atopy has a genetic background for sure, but it is also very influenced by environmental factors; the development of this condition depends on the early exposure to food allergens or inhaled allergens (mites, animal epithelia, dust), on the high level and chronicity of the exposure, on the pollution (by inducing an inflammatory response type TH2), on the social- economical high level (minimizing the parasites and viral infections switches the cytokine secretion profile to phenotype TH2). 
Among the environmental factors which lead to atopic dermatitis occurance and development, the most important are: some food such as cow milk, eggs, fish, peanuts and nuts and inhaled allergens such as pollen and the home dust mite. The relationship between these allergens and the symptoms is 
often hard to prove, unfortunately. Together with these factors, the big changes in the lifestyle, the     exposure to irritants and pollutants, the decreased number of infections (vaccines), modify the immune response of the body. 

Symptoms 

Usually, the skin with atopic dermatitis is inflamed and itching, causing redness, papules and crusts, but it's true that there are rare cases when the child doesn't feel any itches. The first signs appear between the age of two and six months, most often at 3 months of age, but there are cases when younger infants were diagnosed with this skin condition. In over 60% of the cases, the atopic dermatitis occurs under the age of one and only at half of the cases the symptoms clear until they reach puberty. The lesions appear especially on the head and face, but they spread to the knees, palms and elbows when the child starts walking. 
The symptoms are often accentuated by skin irritants such as wool and synthetic clothes, some soaps, hot water and higher environmental temperature. During the summer, the symptoms of skin condition may reduce until they disappear, and they reappear during autumn and winter. The mental irritability accentuates the disease: pruritus - scratching - skin rashes - scrapes. 
The atopic dermatitis often gets infected with bacteria, fungi and viruses. The most frequent infections are with staphylococcus and herpes virus. They accentuate the disease. 

Statistics: 
Heredity: genetic predisposition, which is present in 2/3 of cases.
Sex: Men = Women; women tend to an unfavorable prognosis.
The affected systems: teguments/exocrine system.
Incidence/Prevalence: Frequent disease: 7-24/1000
Age: it usually occurs in the childhood, after the age of two months. It affects 5% of the world population of children. 90% of the patients are around 5 years old. d 

Children between 0 and 2 years old. 

Infant atopic dermatitis lasts till the age of 2. The first skin signs appear in the third month of life. At this stage, the atopic eczema displays exudative pruritic papules and vesicles, especially on the cheekbones, on the forehead, retroauricular, on the body, and on the extensive areas of the limbs. The infant scratches often especially during the night, he is irritable, he cries a lot and wakes up more times during the night. Often the scratched lesions get infected. 

Children between 2 and 12 years old. 

Regarding the atopic dermatitis in children between 2 and 12 years old, the atopic eczema is less exudative, the skin becomes thickened (lichen like), especially at limbs flections (knees, elbows, ankles), eyelids and neck. The intense pruritus still exists especially in the acute staged. 

Diagnosis and treatment 

There are no relevant laboratory tests for the diagnosis of atopic dermatitis, this being based on the clinical symptoms and on the exclusion of the other types of dermatitis. 

Treatment principles 

Natural diet 
The breastfeeding until the age of 6-7 months is the best method to avoid the occurance of atopic eczema. This is due to the fact that a mother has a high concentration of vitamin C in the body during breastfeeding, and the child will be less exposed to the risk of developing atopic dermatitis. 
Diversified diet 
When the diversification begins, you must avoid citrus, whole milk, eggs, fish until the age of one year. The foods that proved to be allergens, must be avoid for a longer time. In children with atopic dermatitis, the rash and the pruritus might be accentuated by certain foods such as: milk, egg, fish, grains, nuts, peanuts, tomatoes, citrus, chocolate, etc. the determination of the food trigger factor is difficult. Together with the skin test which has a limited value, the elimination diet must be followed. This consists in a basic diet, which doesn't contain the suspected food, and which is maintained until the skin lesions disappear and then, the suspected foods are reintroduced one by one. If the elimination diet reduced the symptoms visibly for more times, the respective food will be avoided for many years. 
Allergens 
The cigarette smoke has a very harmful effect by increasing the risk of developing allergic respiratory symptoms: rhinitis and asthma. In order to avoid the sensitivity to the mite in the home dust (indoor air allergen) and the occurance of rhinitis and asthma, the dust collectors around the child should be reduced to minimum. The allergens are many, so that we recommend you to see the allergist doctor in order to determine what allergens affect your child, at the right testing age. 
Hygiene 
Only the oily soaps, special for dry skin and without coloring or perfume, are allowed. The bathing must be short and the water not too hot, not to accentuate the symptoms. It is recommended that you add a handful of bran in the bathing water. After bath, the skin must be hydrated daily with oily ointments which don't allow the skin to get dry. You must cut the nails short to prevent the thickening and the skin infection. 
Clothes
It is recommended to wear white cotton clothes, and you must wash them with mild detergents and then rinse them well; don't use laundry fresheners for rinsing (scented clothes softener). The child must be dressed according to the environmental temperature. The excessive dressing and the running cause sweat, which accentuates the pruritus. You must stop the scratching of the lesions. 
Beneficial factors 
The sun and sea water reduce the atopic symptoms. If the lesions are exudative or infected, you must avoid the contact with sand. 
Family environment
You must ensure an affectionate and calm family environment. The fuss around the child, decreases the pruritus limit. 

Medical advices 
  • The skin conditions must be treated, and the child must be isolated in case there is a person infected with Herpes Simplex around him. 
  • The treatment with corticosteroids as ointments, is applied only at the dermatologist or allergist prescription and in the doses they recommend it. It is strictly prohibited to be applied at the parents or the patients initiative, because of the possible side effects in long term. They will not be applied on the face in any way. 
  • The treatment with oral antihistamines is good. The reducing of pruritus will interrupt the vicious circle of this disease. Thus, the general evolution of the disease is very improved. 
  • The antihistamines are prescribed to reduce the pruritus (itching), but as they have a sedative effect, they are usually administered in the evening. 
  • It is not recommended to treat the skin conditions with locally applied antibiotics, because of the high risk of developing contact dermatitis too. It's obvious that there are exceptional cases too, and if the specialist considers that the local antibiotics are necessary, follow his advice or ask for a second opinion. 
  • Natural extract, such as the Dead Sea ones, may have good results and represent an alternative to the corticosteroids. 
Advices for parents 
  • The education of the children with atopic dermatitis is decisive for the therapeutic success and for increasing the quality of life. 
  • The parents should know that they should focus on the controlling the disease and not on treating it. 
  • Don't forget that atopic dermatitis cannot be cured, but most cases tend to improve spontaneously and gradually. The control of the symptoms depends on the complying of more treatment rules established by the allergist and dermatologist, under the constant supervision of the GP. 
  • It is important to prevent the accentuation of the disease and not to apply ointments at any sign of pruritus. If your child has a face rash which causes itching and doesn't resolve with time, take him to the doctor. 
  • It is very important for the patient and his parents to accept that the atopic dermatitis is a chronic disease, which needs care and constant medical supervision in order to interrupt the vicious circle pruritus- scratching. 
  • The diagnosis is determined after clinical tests and the laboratory test are generally not necessary. There, the parents are taught the right application method of the ointments and creams. Ask the specialist if you something is not clear. 
  • The treatment of the atopic dermatitis is efficient only if you take many other simultaneous measures. There is no treatment to stop the symptoms completely or whose side effects on long term are less important than the disease itself. The immunotherapy with anti-allergic vaccines is not efficient in the atopic dermatitis. 
  • As the atopic dermatitis is a genetic disorder, you may let your child play with other children, THE DISEASE IS NOT CONTAGIOUS! 
Possible complications 
  • Eczema herpeticum may occur after the chickenpox vaccine. It starts suddenly, with a severe evolution and needs hospitalization. 
  • Cataracts is very frequent in patients with atopic dermatitis. 
  • Skin infections, especially with Staphylococcus, sometimes in subclinical forms. 
The advices in the article must be applied to complete the medical care and not to replace it. If you child is under the supervision of a specialist, and his advices are opposite to the ones found in the article, follow the doctor's advices, as he knows the case better. 





Read the English version of this article: Atopic Dermatitis in Little Children (Atopic Eczema)