Atopic Dermatitis

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Atopic Dermatitis or Eczema is a common chronic skin condition in children, which causes itchy red scaly areas on the face and body. It generally improves spontaneously before the child enters adolescence. Rarely, it persists into adulthood.

It usually occurs in children who have an ‘atopic tendency’, that is to say, it is common among individuals who have eczema, asthma and/or hay fever (Atopic Triad) among other family members, say a parent, child or sibling.

Eczema is treated with antihistamines to relieve itching, medicated creams and moisturizers. When the eczema involves large areas of your skin, you may be treated with oral medications or light therapy. The active lesions can be treated completely. The real challenge is to maintain the remission and prevent the flares.

Key Points:

• Avoid excessive bathing and prolonged contact with soap or detergent. Use the soap prescribed by your dermatologist.
• Keep your skin adequately moisturized at all times. Use mild, fragrance-free, paraben-free moisturizers. Moisturize your skin 3 to 4 times a day.
• Avoid scratching, rubbing, and picking the skin. This aggravates eczema and may also lead to secondary bacterial infection and unsightly pigmentation.
• Avoid strong perfumes, food with artificial colors and flavors, woolen and silk clothing, and keep the house free from dust and pollen.
• Atopic patients are slightly more prone to bacterial and viral skin infections, which must be attended to immediately.

Seborrhoeic Dermatitis

Seborrheic dermatitis (SD) is a common skin disease occurring predominantly in infancy and middle age, exhibiting distinct variations across these age groups. It is seen on the oily areas of the body such as the scalp, face, upper chest, back and groin. There is a greasy, yellow scaly rash on the affected areas. On scalp, it presents as dandruff. Because it often resembles other dermatoses, SD necessitates accurate differentiation.

Infants are usually extensively affected by SD, which often appears as firm, greasy scales on the crown and frontal regions of the scalp that can cause significant parental anxiety. Infantile seborrhoeic dermatitis (ISD) occurs during the first 3 months of life and is also known as “Cradle cap.” It is mild, self-limiting, and in most cases, resolves spontaneously by the first year of life.

Treatment for seborrheic dermatitis usually involves a corticosteroid cream, an antifungal cream, or a combination of both. An antifungal shampoo may be added, which directly targets the Malassezia fungus that exacerbates symptoms. Tar and salicylic acid-based shampoos are added if the dandruff is thick and flaky.

Contact Dermatitis

It is a skin condition that develops as a reaction to an external substance. Treatment will depend on the underlying cause. Contact dermatitis is classified as either Irritant or Allergic.

Irritant Contact Dermatitis

Irritant contact dermatitis accounts for 8 out of 10 cases of contact dermatitis, according to the National Eczema Association (NEA). It can occur when your skin frequently comes in contact with irritating materials like soaps and detergents. For example, people who frequently wash their hands such as housewives, healthcare workers, hairdressers, and food handlers experience irritant contact dermatitis on their hands.

Other substances that may cause irritant contact dermatitis include bleaches, cleaners, disinfectants, sanitizers, kerosene, and chlorinated water in pools.

Allergic Contact Dermatitis

This occurs when your skin develops an allergic reaction after exposure to a foreign substance. This causes your body to release inflammatory chemicals that can make your skin feel itchy and irritated.

Common allergens include nickel (in jewellery or watches), latex, perfumes or chemicals in cosmetics, and balsam of Peru found in foods and skincare products. Patch testing is conducted to identify the allergen whenever allergic contact dermatitis is suspected.

Common Symptoms:

• Dry, scaly, flaky skin
• Blisters
• Burning or stinging
• Skin that feels stiff or tight
• Sun sensitivity
• Hives

Preventing Contact Dermatitis

• Rinse affected skin with warm water and an emollient as soon as possible.
• Use gloves to protect your hands — always wear cotton gloves under latex gloves.
• Switch to mild cleansers and soaps.
• Apply emollients frequently and generously to keep your skin hydrated.

Topical corticosteroids are used for severe symptoms. For widespread or severe contact dermatitis, oral corticosteroids or other immunosuppressants may be prescribed.

Airborne Contact Dermatitis (ABCD)

This is a morphological diagnosis that includes all acute and chronic dermatoses of the exposed body parts caused by airborne substances. In India, Parthenium dermatitis is the most common form of airborne contact dermatitis.

Diagnosis is based on:

• The presence of a volatile or airborne causative agent
• The clinical presentation
• Patient history
• Patch testing

Commonly affected areas include the face, dorsal hands, neck, upper chest, and forearms. Eyelids may be the only site in some cases. Symptoms include itching, burning, stinging, and scaly or crusted plaques.

Treatment includes:

• Emollients
• Topical corticosteroids

For severe cases:

• Systemic steroids
• Azathioprine
• Mycophenolate
• Methotrexate
• Ciclosporin

Key Points:

Airborne contact dermatitis can significantly affect quality of life. Avoiding the allergen can often lead to full recovery. In severe cases like Parthenium dermatitis, long-term immunosuppression may be necessary. Some patients may progress to chronic actinic dermatitis.

Note:

URTICARIA and ANGIOEDEMA are covered under separate headings in the main menu.