Atopic Dermatitis
When we talk about atopic dermatitis (AD), we are referring to a skin condition which is one of the causes of eczema. Eczema is basically inflamed skin that can lead to itchiness and chronic flare ups. Some common and related symptoms of AD are allergic rhinitis (a fancy medical term for allergies to things like grass, trees, and moss that can trigger nose and sinus inflammation, also known as “hay fever”) and asthma.
AD is very common in all populations and frequently first appears with more severe symptoms in childhood and young adolescence with a tendency of such individuals to “ outgrow” this chronic condition as they age. We emphasize the chronic nature of AD because it is important to understand that this is a persistent, often inherited skin condition which is prone to relapses. The ones suffering from AD will always have to take constant care of their skin and avoid factors which can trigger eczema.
It is important to understand that regardless of whether you are currently symptomatic or not, AD is a chronic disease. Minimizing potential triggers and maintaining a good skincare practice is essential!
The mechanism behind AD explained in a nutshell...
If there is one key point I want you to take home from this article it would be that what causes AD is the fact that the epidermal barrier is disturbed! Imagine a sheet of paper with little holes so that anything on that paper will find its way through these little gaps. Now imagine your skin integrity has loosened up, so things like allergens, bacteria, dust, dirt, and toxins can pass the barrier easily to attack the layers of your skin. Itching makes this process even worse since you contribute to destroying your epidermal barrier, making it even easier for exogenous factors (factors that come from the outside) to pass through.
Typical findings are a low hydration of the stratum corneum which is the top layer of your epidermis and a higher TEWL (transepidermal water loss, for those who missed this: go back to our lesson on the epidermal barrier), a higher PH and an alteration of the microbiome (which increases your risk of skin infections).
What does atopic dermatitis look like ?
Typical symptoms of eczema are inflammation, itchiness, redness and edema (swelling). In adults, AD can sometimes present as ‘only’ dry skin with a tendency to redness especially with changes in weather. Common problem areas in both children and adults are the head (specifically the eyelids for some people), neck, flexor surfaces (legs and arms), hands, and feet.
Let’s talk about potential trigger factors !
Fragrances (also a very common cause for contact allergies), food allergies, citrus fruits, dry dusty environments, winter, harsh detergents, stress, smoking, over-bathing… to name the most common.
Winter often leads to flare-ups because of the amount of time we spend in indoor heated areas and with lower humidity. On the other hand, while many people experience symptom relief with exposure to the sun and warmth, excess heat, humidity, and sweat may also be counterproductive.
Of course, this is not a one-size-fits-all situation. Paying attention to how your skin reacts to certain things will help you to notice what triggers your eczema or skin rashes in general.
CLINICAL PRESENTATION
In skin of color , just more pigmented skin, redness (a sign of inflammation) can be less notable leading to false assessment of the severity. Furthermore, small and densely positioned papules are another common presentation beyond the typical signs.
Hyperpigmentation is the result of chronic inflammation, and if it remains under-treated, it can then result in dyschromia which are lighter and darker patches of skin.
Practical tips:
Look for products labeled “sensitive-skin” including detergent, hand soap, etc.
Choose cotton clothing and undergarments whenever you can.
Be selective with your jewelry. (Nickel is a common allergen, fake jewellery that rubs off on your neck is an obvious no no...)
Avoid long hot showers and long baths when possible. (Learn more about bathing with skin soothing ingredients)
Moisturize with a lipid rich barrier protective cream from head to toe within minutes after bathing to lock in that moisture. (check out our skincare section for our favourite hydrating moisturizer)
Cream is always better than lotion, milk or gel formulations, since the higher the water percentage in lotions, milks, and gels will tend to dry out already dehydrated skin. The thinner the texture, the more water based it is. (For example, compare shea butter cream to aloe vera gel)
In skin of color, erythema (redness) might disguise by its more violet or greyish tone which causes under-diagnosis and under-treatment. Learn to recognize if you suffer from redness and point them out if you have to!
Sometimes redness might also appear as a post inflammatory hyperpigmentation (PIH) even though it is still an inflamed area! Therefore it is always important to search for healthy skin first as a baseline in order to properly categorize the hyperpigmented skin area.
Sometimes inflamed skin in darker skin tones seems to look like a PIH even though it is still inflamed! Very important: search for healthy skin first, then compare it to the eczema patch.
ABC Therapy:
In an acute phase, topical steroids will quickly do the job: decrease inflammation. A like Anti-inflammatory. Picture it as your little rescue plan! But remember that barrier treatment (redness, itchiness) is an important consideration for acute phases and constant care. Think about wounds that have to heal… you might want to apply a thick soothing cream that you use for any damaged skin. B like barrier treatment. Since it's all about maintenance, constant barrier protection helps to maintain healthier skin and lessen the occurence of flare ups. C like constant care.
Choose a daily moisturizer to restore and protect your epidermal barrier.
Furthermore, dermatologists also recommend a proactive treatment regime for patients who have AD. This includes the use of topical steroids that can be applied 2x/week on problem areas (not the face unless your doctor advises you to do so!) which tend to continually flare up, in addition to barrier treatment.
Please note that since AD is a chronic skin condition we cannot recommend further treatment regimens as AD has to be treated and monitored by your doctor.
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