Some children suffer from severe eczema soon after birth, with itchy, untreated skin. After the “eczema” gets better, the skin is dry and peels. After a short recovery, the eczema will soon return, over and over again. The child suffers endlessly because of the itching, and the parents are around to worry about it, but they can’t do anything about it.
Many times this recurring skin condition is mistaken for “eczema” by parents, but what the child is suffering from is actually atopic dermatitis.
Unlike common eczema, patients with atopic dermatitis are very young and often have a family history of allergies. The eczema often grows in the elbow fossa or the N fossa behind the knee (which is where the ancient term “four bends of wind” comes from), with dry, intensely itchy, recurrent skin all over the body. This kind of eczema, which grows in uncommon places, was once called “atopic dermatitis” and “hereditary atopic dermatitis” because patients often have hereditary allergies (atopic The rash was once called “atopic dermatitis” and “hereditary allergic dermatitis” because the patients often have hereditary allergies (atopic), so it was later called “atopic dermatitis”.
What are the symptoms that may indicate atopic dermatitis in children?
In 1994, Williams, a British physician, developed a minimum criteria for diagnosing atopic dermatitis, with the following six diagnostic points.
1, history of pruritus (thick black triangle refers)
2. History of generalized dry skin (dry, cracked skin)
3, history of flexural skin involvement (elbow fossa, N fossa behind the knee, etc. had a dry or rash)
4. Age of onset before 2 years (cat holding pacifier in left paw)
5, flexural skin with eczema (elbow fossa, N fossa and other areas are suffering from eczema)
6. Personal history of asthma or allergic rhinitis, or a family history of atopic dermatitis in first-degree relatives (cats with runny nose)
The diagnosis of atopic dermatitis is made when item 1 is required, plus 3 or more of the other 5 items.
Daily care for patients with atopic dermatitis
When a patient with atopic dermatitis is in an episode, regular medication should be administered under the guidance of a dermatologist. In addition, daily care should not be neglected, as it is not only the cornerstone of treatment, but also an important safeguard to prevent recurrence of the disease during the remission period. In daily life, we mainly focus on the protection of the skin barrier and reducing the chance of allergen exposure, with four major points: clothing, food, housing and washing.
Clothing: choose cotton fabrics for intimate clothing, rather than plush, silk, chemical fiber fabrics, to prevent triggering skin allergies or itching irritation. Laundry rinsing thoroughly, try not to use softener.
Food: Avoid foods that can cause allergies. If your child has been formally tested for allergens (serum specific IgE or skin prick test) and has a clear allergen, you should try to avoid foods that contain allergens.
Housing: Keep the environment clean, ventilated and cool. Plush toys should be washed frequently, and pets with fur or feathers should be kept indoors as much as possible.
Bathing: Bathing is the most important thing for patients with atopic dermatitis, and improper bathing directly affects the condition of the skin. Patients should try to take a shower rather than a tub bath, and use softened water for bathing when available. If a tub bath is necessary, try to stay in the tub for less than 5 minutes, and the water temperature should not be too hot. Although hot water can temporarily suppress the itching sensation, it is not good for the skin in the long run. Try to use a mild, unscented liquid cleanser or even a bath oil or non-foaming cleansing product to avoid excessive sebum loss leading to dry skin. After showering, gently pat the skin dry and use a non-irritating emollient product all over the body within 3 minutes.
Care of atopic dermatitis during flare-ups
Atopic dermatitis is often severely itchy with erythema, papules and oozing during the flare-up period. In addition to taking medication and topical drugs under the guidance of a dermatologist, it is important to use cold and wet compresses appropriately. Sterile water, saline, boric acid solution, etc. can be soaked in gauze (or clean clothing), wrung until half dry, applied to the damaged skin, 10-30 minutes each time. Cold and wet compresses can quickly increase the water content of the skin stratum corneum, reduce the surface temperature of the skin, to reduce the inflammatory response, constriction of blood vessels, clean skin, effective anti-itch effect.
There are also a variety of high-pressure cans of mineral spring spray on the market, not only can be sprayed directly and evenly for easy use, but also to ensure the sterility and cleanliness of the water when wet compresses. Some mineral springs contain silicates and other ingredients that can help repair the skin barrier, making them more suitable for people with atopic dermatitis in the acute stage.
Why does atopic dermatitis recur in children?
So far, the exact cause of atopic dermatitis is not fully understood. In fact, it is clear from the other name of atopic dermatitis, “hereditary atopic dermatitis”, that a very critical part of the factor in the development of atopic dermatitis is the allergic constitution inherited from the parents to the child. This constitution is difficult for us to change and we can only gradually adapt to it.
In addition, the onset of the disease is also influenced by the environment. In hot, humid, or cold weather, or when sweating or bathing frequently, the integrity of the skin barrier is compromised and allergens are more likely to enter the body. The use of emollients will help to repair the skin barrier, which is the theory behind the improvement of the patient’s symptoms with skin care.
Tip: What is the skin barrier?
The four parts of the skin: surface lipids, keratinocytes, intercellular lipids and natural moisturizing factors, all work together to form the complete skin barrier. They moisturize the skin, prevent excess water from evaporating outward from the skin, and also inhibit the growth of harmful microorganisms on the skin surface. Patients with atopic dermatitis have one or more of these components that are weaker than the general population and can experience flare-ups or relapses if the environment is not suitable or care is not appropriate.
How does atopic dermatitis develop?
The specific pathogenesis of atopic dermatitis is quite complex, and we recommend the following section for those who are particularly interested in this disease. The following chart summarizes the pathogenesis of atopic dermatitis for which preliminary research findings are available.
1. Disruption of the epidermal barrier.
2.Langerhans cells presenting allergens
3, Inflammatory response
4, Immune cell TH1/TH2 imbalance
5. Expansion of inflammatory response by eosinophils
6. Bacterial multiplication
7.Phytodysfunction (scratch-itch vicious cycle)
8, genetic basis (atopic physique)
To learn more, you can read the detailed description of the pathogenesis at the end of this article.
Summary.
Atopic dermatitis is not yet completely cured medically, but through proper care, we can do to effectively reduce the recurrence of the disease and improve the quality of life of patients. Parents need to guide their children to correctly understand the disease, adapt to the existence of this chronic recurrent disease, live peacefully with it, manage the disease under the guidance of a doctor, and reduce the interference of the disease in their lives, which is the core idea of the management of most chronic diseases.
*Detailed explanation of the pathogenesis.
1. Destruction of the epidermal barrier: An intact skin barrier can isolate the body from external harmful factors, resist their invasion and damage to the body, and prevent the loss of nutrients and water in the body. For patients with atopic dermatitis, their epidermal barrier is often very fragile and easily damaged. If they are not careful, their integrity will be damaged, and external irritants and allergens will easily enter the skin, stimulating the release of pruritus-related inflammatory mediators (such as histamine and substance P, etc.) and producing intense itching.
2, Langerhans cells present allergens: The human epidermis has a special kind of immune cells called Langerhans cells, which have many dendritic structures on their surface. If we compare the human immune system to an army, then Langerhans cells are equivalent to the sentinels of the army. When it detects a foreign molecule entering the epidermis, it reports this signal to the body’s immune system. The immune system then decides whether to initiate an inflammatory response to remove the foreign substances or to ignore them. Due to the disruption of the epidermal barrier, Langerhans cells are more easily exposed to foreign substances, so they will more frequently present foreign substances, some of which are allergens, to the immune system. These allergens will trigger an inflammatory response of the immune system.
3. Inflammatory response: Inflammatory response is like a “fire” lit by the immune system in the body, which not only burns off the enemy, but also hurts our own people. Allergens are such a substance, which itself does not cause much damage to the body, but when the immune system encounters it, it will be reluctant to ignite the fire, resulting in a large number of inflammatory substances and effector cells produced in the body to accidentally injure themselves. This is the inflammatory response triggered by allergies. In patients with atopic dermatitis, the skin surface is like a battlefield, often dry and peeling and scarred, because the immune system frequently initiates the inflammatory response.
4. Immune cell TH1/TH2 imbalance: Families often ask doctors if their children have atopic dermatitis because their immunity is too low. This is not the case. The degree of immune response in the body is mainly regulated by T helper cells (TH cells), which are divided into two main types, TH1 and TH2. The two types of T helper cells interact with each other to form a certain balance. TH2 cells promote the synthesis of more immunoglobulin E (IgE), which recognizes and binds to specific external allergens and triggers subsequent allergic reactions. TH2 cells in patients with atopic dermatitis tend to be over-activated, making the patient prone to allergies from time to time. So the problem with atopic dermatitis is not poor immunity of the body, but an imbalance in the immune system.
5, eosinophils expand the inflammatory response: the human body has a type of white blood cell called eosinophils. The proportion of eosinophils in the blood of normal people is very low, while in some allergic people, the proportion of eosinophils will be significantly higher. The combination of eosinophils and IgE, which recognizes specific allergens in the body, triggers a subsequent inflammatory response that amplifies an otherwise very small stimulus, thus aggravating the manifestation of the disease.
6. Bacterial colonization: The integrity of the skin barrier is essential to resist infection by harmful microorganisms. Patients with atopic dermatitis have a number of harmful microorganisms multiplying on the skin surface due to the destruction of the skin barrier, with Staphylococcus aureus being the most representative. This bacterial proliferation causes localized skin infections, and in addition to affecting skin barrier repair, the metabolites of the bacteria themselves can become allergens or even superantigens that can cause stronger inflammation, thus aggravating the itching and inflammatory response. Therefore, topical antimicrobial drugs are also one of the important aspects of treatment during episodes of atopic dermatitis, especially in lesions with exudation.
7. Phytodysfunction (scratch-itch vicious cycle): Itching was once thought to be a specific kind of pain, but later studies have shown that itching is felt and transmitted by independent neurons and is not the same as the neural sensory and conduction mechanism of pain. Stimulation of the skin by nerve endings receptors in the lower stratum corneum can produce the sensation of pruritus. Scratching temporarily controls itching through neural inhibitory mechanisms, but instead makes the nerves more sensitive to mechanical stimuli. Scratching also stimulates the skin and increases the release of itch-related inflammatory substances in the skin, bringing about more intense itching, forming a vicious cycle of “itch-scratch-itch”.
8, genetic basis (atopic body): atopic dermatitis patients often have a family history of allergies to a variety of external substances to produce allergic reactions, suggesting that the disease is related to hereditary allergies. In addition, many patients with atopic dermatitis have abnormalities in the structure or function of epidermal filoproteins, and this abnormality results in reduced levels of natural moisturizing factors in the skin; patients also have significantly reduced ceramide levels in the stratum corneum, and therefore a fragile or incomplete lipid barrier in the skin. The genetic basis determines that atopic dermatitis is difficult to cure. The skin barrier of these patients is more easily damaged than normal and requires long-term care to prevent the recurrence of symptoms.