Part One: What is Atopic Dermatitis?


What is Atopic Dermatitis?


Atopic Dermatitis, also frequently termed ‘Atopic Eczema’ or ‘Eczema’, is the most

common chronic inflammatory skin disorder seen in patients globally. Atopic

Dermatitis is characterised by itchy dry lesions and possesses a multifaceted

pathogenesis involving both genetic and environmental underpinnings. Atopic

Dermatitis mostly arises in childhood, with research declaring that approximately

60% of childhood cases begin in the first year of life.


What are the signs, symptoms and clinical manifestations of Atopic

Dermatitis?


Atopic Dermatitis frequently bestows in patients who have what is called an ‘Atopic

Tendency,’ or the ‘Atopic Triad.’ This means sufferers may acquire all three closely

interconnected conditions; Atopic Dermatitis, Asthma and Rhinitis (hay-fever), in a

sequential manner.


Specific to the cutaneous presentation of Atopic Dermatitis, there is quite a disparity

amongst individuals, though the main manifestations involve:

  • Erythema (redness)

  • Oedema (swelling)

  • Crusting

  • Weeping

  • Pruritus (itching)

  • Excoriation from excessive scratching

  • Lichenification / lichenified plaques (thickened skin)

  • Xerosis (dryness)

  • Scaling

  • Cracking

  • Fissuring

  • Vesicles (blisters)

  • Pigmentary alterations

  • Erosions

  • Bleeding


The anatomically affected regions of Atopic Dermatitis are dependent upon the age

range of the sufferer:

  • 3 months – 2 years: the scalp (also commonly termed ‘cradle cap’), cheeks, neck, extremities and trunk are affected, while the diaper region is usually spared.

  • 2 – 12 years: The outer aspects of joints, as well as the wrists, elbows, ankles and knees are generally disturbed.

  • 12-60 years: The affected regions include the head, neck, hands and flexural regions.

  • 60+ years: The flexural regions are usually spared, and it is important to note that a number of differential diagnoses which may mimic Atopic Dermatitis must be excluded.


Atopic Dermatitis and the skin’s barrier


One of the exclusive hallmarks of Atopic Dermatitis is a deficiency in the skin’s

barrier functionality. The Stratum Corneum is composed of corneocytes which are

responsible for secreting intercellular substances (filaggrin). These breakdown into

constituents, such as amino acids (Natural Moisturising Factors) and lipids

(ceramides) which then operate to arrange a barrier layer which defends the

epidermis against environmental insults. But in Atopic Dermatitis patients, there are

numerous alterations and deficiencies in the proteins and the lipids of the Stratum

Corneum, resulting in bacterial colonisation and hence secondary bacterial, viral and

fungal skin infections.


Atopic Dermatitis and the environment


Atopic Dermatitis sufferers will often discover their condition is exacerbated

throughout winter. The water content of the epidermis mirrors the environmental

humidity levels and owing to the reduced humidity levels in the cooler months the skin becomes considerably drier, resulting in impairment of the natural barrier

function and thence the potential for secondary skin infections.


Atopic Dermatitis and COVID-19


COVID-19 has seen numerous alterations in Atopic Dermatitis patients. Alcohol-based sanitisers containing at least 60% ethanol are recommended for hand hygiene, as the alcohol is able to denature proteins and thus inactivate enveloped viruses including coronaviruses. Excess use of sanitisers can lead to skin dryness, itching, burning, erythema, scaling and vesiculation through depletion of skin surface lipids allowing penetration of detergents into the epidermis.

Additionally, it is marked in research that other various factors resultant of the coronavirus are responsible for exacerbating this chronic condition, these include:

  • Repeated hand washing and sanitising which causes further disruption to the skin’s barrier

  • Adverse psychological effects which have increased pruritus in Atopic Dermatitis sufferers

  • Reduced UV exposure in aggregation with high temperatures and low humidity have exerted an immunosuppressive effect on the skin

  • Greater exposure to indoor pollutants

  • Reduced routine dermatologic visits

References


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Schäppi, G., & Schmid-Grendelmeier, P. (2017). Clinical phenotypes and

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De la O-Escamilla, N. O., & Sidbury, R. (2020). Atopic dermatitis: Update on

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