1. What is atopic dermatitis?
Atopic dermatitis is a chronic skin disease associated with genetics, characterized mainly by itchy, chronic, recurrent, skin disease with other allergic diseases.
There are many clinical manifestations of atopic dermatitis, which can be divided into three stages: infancy, childhood and adolescent-adult according to the characteristics of rash onset, development and distribution. Studies have shown that: 45% of children with atopic dermatitis have an onset within 6 months; 60% of children with atopic dermatitis have an onset within 12 months; 85% of children with atopic dermatitis have an onset before the age of 5 years; and 16.8% of children with atopic dermatitis have an onset after puberty.
Atopic dermatitis develops within 2 years of age and is called infantile eczema, with lesions mainly on the cheeks, forehead, scalp and neck. The lesions are mainly of the exudative and dry type, with the former being more common in clinical practice. Many children develop the rash a few months after birth and typically present with itchy skin accompanied by erythematous patches with dense blisters and pinpoint papules. It is also sometimes called infantile eczema or tinea cruris when it develops in infancy.
The childhood phase refers to children aged 2-12 years and mostly evolves from the infantile phase, when the scalp layer may be a little better than the original. The lesions are mainly of the eczema and itchy rash type, with typical sites of onset in the anterior elbow fossa, N-fossa, flexural wrist, eyelids, face and neck. The most subjective symptom of this period is intense itching, so that a large number of scratches on the lesions are followed by infection, resulting in a vicious cycle of “itching – scratching – itching”. The lesions in adolescence and adulthood are similar to those in childhood, and are mostly limited dry dermatitis lesions, erythema or papules, which fuse to become mossy skin with grayish white scales. The lesions mainly occur in the elbow fossa, N fossa and anterior and lateral parts of the neck, with the flexion side being the most important. In this process can be accompanied by other allergic diseases, such as asthma, allergic rhinitis and so on.
2. What is the pathogenesis of atopic dermatitis?
The cause of atopic dermatitis is very complex and has not yet been fully understood. It is mainly related to genetics, environment, skin barrier function and external allergic factors. In atopic dermatitis associated with genetic factors, usually if both parents have allergic diseases, such as atopic dermatitis or allergic rhinitis, the probability of the child getting atopic skin disease is 50-75%. If one parent has the disease, the child’s chance of getting the disease is 25-50%. If both parents do not have them, the child’s chance is 7-25%. In addition, abnormal skin barrier function can also have an effect on the disease. There may be a relationship between abnormal skin barrier function and genetic factors, as genetic factors cause the skin barrier function to be incompetent and more likely to get the disease.
Environmental factors are also one of the factors that have led to an increase in the number of patients with atopic dermatitis year by year in recent years. There are also a number of allergens that can act as atopic triggers, including airborne allergens, food allergens, and microorganisms.
Diet can also have an impact on the development of atopic dermatitis, especially in children who eat certain seafood, milk, eggs, etc. It can also aggravate the condition. Weather factors, such as dryness in the fall and winter, may increase the incidence of the disease; in the spring, there is more pollen of various kinds, and pollen causes allergies to worsen. In addition, insect mite allergy is also an important factor in the development of atopic dermatitis.
There are also some atopic dermatitis that are not caused by allergic factors. For example, burning, excessive friction or the use of some alkaline lotions and other stimuli can also have a triggering effect on the disease. In addition, some mental factors such as anxiety, tension on the onset of the disease will also have an impact.
3.What are the manifestations of atopic dermatitis?
Atopic dermatitis is a long and slow disease that lasts for more than a few months or years, alternating between relapses and remissions. Pruritus and rash are the core clinical features of patients with atopic dermatitis. Because atopic dermatitis also has a genetic history, a history of atopic dermatitis in both parents is one of the diagnostic criteria. In addition, the presence of allergic diseases such as asthma, allergic rhinitis, allergic conjunctivitis, gastroenteritis, etc., can also be used as a diagnostic criterion. Of course, there are many other features, such as dark haloes around the eyes, periorbital keratosis, skin scarring, or other manifestations, which can also be used as diagnostic criteria for children with atopic dermatitis. The diagnosis of atopic dermatitis should be made by a specialist in the dermatology department of a regular hospital for differential diagnosis.
4. Is atopic dermatitis the same as eczema?
The concept of eczema is a relatively broad, atopic dermatitis is narrower, mainly eczema with a family history of allergies. The first clinical symptom of atopic dermatitis is itchiness, and the second is the appearance of a symmetrical rash, which varies from age to age. Within one year of age, it is on the extensor side of the face and extremities; after one year of age, it shifts from the extensor side to the flexor side, and once the child reaches two years of age, it shifts to the four fossae (elbow and N fossae). In addition to the manifestations of eczema, patients with atopic dermatitis even have other allergic diseases, such as allergic rhinitis, allergic asthma and so on.
5. Is there a high incidence of atopic dermatitis?
The incidence of atopic dermatitis is higher in industrialized developed countries than in underdeveloped countries, and the incidence is higher in urban areas than in rural areas. The incidence is higher in Europe and the United States, where more than 20% of children are affected and the incidence is increasing every year. The incidence in China is also increasing year by year.
6. Is atopic dermatitis not a hereditary disease because it does not show symptoms in childhood?
No, hereditary diseases do not necessarily manifest themselves at birth, they have a genetic component and can manifest themselves some time after birth.
Atopic dermatitis is more likely to develop in childhood, and the onset of atopic dermatitis is more severe and prolonged in children, with remission periods becoming longer as the affected child gets older. It turns out that we don’t pay much attention to the onset in adults, and in recent years, a number of adults are often diagnosed with atopic dermatitis in clinical practice.
7. What are the treatments for atopic dermatitis?
Because atopic dermatitis has a long course and is prone to recurrence, the treatment of patients with atopic dermatitis should use different treatment protocols at different times. In Europe and the United States, and in our country, we have developed relatively standardized guidelines for the diagnosis and treatment of atopic dermatitis.
Currently, the preferred treatment for atopic dermatitis in China is still glucocorticoids plus emollients, but most patients and their families are afraid of treatment with hormonal drugs. Moreover, atopic dermatitis is characterized by a chronic course and easy recurrence, and long-term treatment with hormonal drugs can bring many side effects. Therefore, patients should be properly treated with hormonal medications under the guidance of a doctor. Of course, different treatment options should also be chosen according to the different stages of the disease and different rash characteristics.
The treatment of atopic dermatitis is a comprehensive treatment, which is divided into the most basic care treatment according to the condition, and drug treatment including topical treatment and systemic treatment. If the skin barrier function is impaired in the early stage of the disease, general care such as emollients or moisturizers may be sufficient to achieve the therapeutic effect of maintaining skin moisture and repairing the skin barrier function, and medication is not required. Properly cleansing the skin and maintaining the barrier function of the skin is also a concern during this period.
If such treatment is not effective and the child is still itchy and still scratching, treatment with some sedative medications is needed. Many parents of children with atopic dermatitis may worry about the side effects of these medications and be reluctant to use them. Medication for atopic dermatitis needs to be used under the guidance of a doctor and the patient needs to be followed up. If the child scratches severely, he or she will keep scratching, which will lead to a vicious cycle of “itch-scratch-itch”, and the skin barrier function will be impaired, thus contributing to the aggravation of atopic dermatitis. If the child’s symptoms are still uncontrolled, some hormonal topical medications or non-hormonal topical medications are needed, which are used alternately depending on the condition. In short, these are required to choose different treatment plans according to different conditions.
8.What are the side effects of hormone creams on the skin when used topically for a long time?
When hormone creams are used on the face and perineum for a long time, because these parts of the skin are easily absorbed by corticosteroids, side effects are relatively easy to occur; they can easily cause pigmentation, skin atrophy, rosacea-like dermatitis, acne-like dermatitis, skin laxity, severe capillary dilation (i.e. red blood), increased skin sensitivity, enlarged pores, increased and thickened body hair and other symptoms. Especially for infants and children, the skin is delicate and should not be used on a large scale for a long time.
9. Why do doctors use hormone creams when they have many side effects?
Corticosteroids have anti-allergic effect of suppressing immune reaction, and can reduce itching, congestion and edema after topical application, so that the inflammatory reaction of certain skin damage can be temporarily relieved and subside.
10.What do I need to pay attention to when using hormone creams for children?
Any drug has adverse reactions and side effects. Hormone drugs are abused in China, and can be prescribed by hospital doctors and readily bought by patients in pharmacies. Hormonal drug treatment can still avoid some adverse reactions if used correctly under the guidance of a hospital doctor. Atopic dermatitis is a chronic relapsing disease, and in some patients the course of the disease lasts from infancy to adulthood. If hormonal drugs are used in large quantities for a long period of time, adverse reactions may occur, such as skin atrophy, thinning, infections and so on. In addition, hormone drugs should not be used on sensitive areas of the skin such as the head, face, and armpits, which can make the side effects of hormone drugs more obvious. Doctors all need to provide appropriate education to patients and patients’ families before treatment, and should do a good job of explaining. When treating children with hormone drugs, it should be noted that children’s skin is different from that of adults, which is relatively thin and tender, so strong or halogen-containing hormone drugs should not be used for treatment, because the irritation of these drugs is relatively high.
11.What are the better topical drugs for atopic dermatitis? What is good about them?
The most representative non-hormonal drugs are tacrolimus ointment and pimecrolimus cream, which is a calcium-regulated neurophosphatase inhibitor. Atopic dermatitis and immune factors also have a certain relationship, topical tacrolimus ointment has a regulatory effect on local immune function, so that the normal or out-of-balance immune status can be repaired to normal level after treatment with this drug.
They do not have the adverse effects of hormones and will not cause skin atrophy, thinning and impaired barrier function of the skin. Moreover, the efficacy of this non-hormonal ointment for atopic dermatitis has been confirmed by the medical community, as it has a strong selective anti-inflammatory effect and can be used for a longer period of time in all areas of the disease, especially on the head, face, neck and other tender areas of the skin. Other ointments include sodium heparin ointment, Xitropan cream, zinc boron cream, zinc oxide cream, etc. When the skin is dry and astringent in the later stages of recovery, non-irritating and moisturizing skin care products can be added, such as Avène, Skin Care, Stave and other pharmaceutical products or Vaseline emollient creams.
12.Do I need to use internal medication to treat atopic dermatitis?
For stubborn hormonal dermatitis or severe hormonal dermatitis, patients can take oral antihistamines, immune regulating drugs, herbal medicines and other drugs under the guidance of a doctor.
13.Does atopic dermatitis have any contraindications and precautions?
During the treatment period, it is advisable to eat light food and avoid some spicy and irritating food and alcohol. As this disease has a long treatment period, and the condition is often recurrent, patients should maintain a good state of mind, do not get angry and anxious.
14.How long does it take to cure atopic dermatitis?
Hormonal dermatitis usually takes 2 months to 2 years, and the cure time is proportional to the strength and time of the hormonal preparations applied topically; moreover, after the facial lesions disappear completely, there is still a high degree of skin sensitivity, and it still takes longer to recover completely; at the same time, secondary hyperpigmentation and erythema (dilated capillaries) are also problems that may exist after patients are cured.
15.How to prevent the occurrence of atopic dermatitis?
Patients with skin diseases, especially those of the face, must use medication under the guidance of a dermatologist at a regular hospital, and should not purchase medication on their own or use hormonal creams topically for a long time. Secondly, avoid the use of self-use or the use of potent cosmetics in beauty salons to avoid the hormonal damage to the skin that may be contained therein.
16.Does atopic dermatitis need to be treated in hospital?
Most patients with atopic dermatitis can be diagnosed and treated on an outpatient basis, but if it is very severe, patients need to be hospitalized for appropriate topical and systemic treatment. When a patient has moderate to severe atopic dermatitis, most of the skin all over the body is itchy, which can be manifested as redness and swelling of the skin or even blisters, which can easily break, and after breaking, there is exudation, vesicles and crusts, and the itching is particularly severe, which requires hospitalization. In addition, if a child with moderate to severe atopic dermatitis is not treated in a timely manner, other complications may arise over time, most commonly sleep disorders, and infections are also common and serious complications, so it is necessary to be hospitalized in a timely manner.
17. Can atopic dermatitis be cured?
Most patients are treated with the appropriate medication, and as they grow older, the condition will gradually decrease and be controlled to some extent. The epidemiological survey has been done in China, about 10% of patients with atopic dermatitis can continue to relapse into adulthood, but there are still some patients who can be controlled before the age of 20. The characteristics of atopic dermatitis and asthma are very similar, the onset of the disease are more in children, the incidence will slowly decline as the age gradually increases.
18. Do I need long-term medication to treat atopic dermatitis?
First, the principle of treatment for atopic dermatitis is to restore the normal barrier function of the skin, to find and remove the triggering and/or provoking factors, and to reduce or relieve the symptoms as the main objective. Second, the long-term management and education of patients with atopic dermatitis is an important and worthwhile topic. Medication for atopic dermatitis can improve the quality of life of patients. After active treatment of atopic dermatitis, long-term maintenance therapy is needed to control flare-ups.
Daily skin care requires the use of emollients, which are an important step in keeping the skin moist.
Due to the side effects of hormonal medications, long-term continuous treatment is generally not recommended. They should only be used when the disease flares up, discontinued when the disease stabilizes, and then used until a relapse occurs again. Due to the safety and efficacy of calcium phosphatase inhibitors, and without the side effects of hormonal drugs, they can be applied in the management of long-term maintenance treatment of atopic dermatitis.
A research trial was done in Europe where an aggressive treatment regimen of 2 times a day was used during the exacerbation phase of atopic dermatitis and then switched to maintenance therapy twice a week for 6 months or even a year after the disease was controlled. The results showed a delay in the first relapse of atopic dermatitis and a reduction in disease severity at the time of relapse in both adult and pediatric patients compared to conventional treatments. This is an excellent treatment for the long-term management of patients with atopic dermatitis. The first prerequisite for this treatment is that the drug must be able to be used for a long time, safely, and hormonal drugs will not achieve this.
19.What is the frequency of atopic dermatitis medication with emollient agents?
First of all, dry skin is one of the diagnostic criteria for atopic dermatitis, so daily use of emollients is essential. Different types of emollients can be chosen for different seasons. In winter, you can use emollients that are stronger in oil, and in summer, you can use emollients that are a little thinner or weaker in oil. If some patients have recurrent episodes and more frequent attacks, they can be treated with topical medications that are safe and effective and can be used for a long time. Once the disease is under control, long-term maintenance therapy is used twice a week to reduce the frequency and severity of recurrence. Calcium phosphatase inhibitors do not have the skin atrophy and capillary dilation adverse effects of hormonal drugs.
20.What should I pay attention to in the home care of children with atopic dermatitis?
Atopic dermatitis is a disease with a long course, prone to recurrence, and is also a seasonal disease. The main clinical symptom of atopic dermatitis is itchy and dry skin, and the autumn and winter seasons are dry, which can easily trigger the disease and make it worse. The daily use of emollients is very important and essential to prevent atopic dermatitis in autumn and winter, and the skin must be kept moisturized during the course of medication. There are many varieties of emollients available, and it is advisable to choose a hypoallergenic emollient. Some emollients contain fragrances, which are best avoided by people and patients who are allergic to fragrances. Theoretically, any emollient can be used, but try to choose a hypoallergenic emollient.
Parents should be aware of the nature of the disease and that over-treatment and abandonment of treatment are incorrect attitudes. Atopic dermatitis is a chronic and recurring skin disease, so it must be treated with patience and confidence. The actual fact is that you will be able to get a lot more than just a few of these. The actual fact is that you will not be able to get rid of this disease forever, once you have the conditions and factors to develop it, you may still develop it later.
Pay attention to keep the skin of the child clean, to avoid co-infection with bacteria or rash aggravation leading to complications.
Bathing is important. Many parents feel that this skin disease can not take a bath, afraid of bathing, not to use soap bath, long-term soap, how to wash off the top of the skin dirty things? General soap or bath products are now acid-based, and even soaking baths, bathtubs can be soaked inside, wash every day is no problem. But after washing must immediately apply moisturizer or moisturizer to the child. The moisturizer should generally be used for children without irritation, moisturizer moisturizer inside try not to contain preservatives or fragrance ingredients, the simpler the composition the better, so that after moisturizing treatment in many cases children’s symptoms, especially itchy symptoms will be reduced or even relieved. If there is itching children always to scratch, then to provide some sedative drugs. Of course, we must be alert to some adverse reactions, what adverse reactions in time to communicate with the doctor, if there are adverse reactions can be promptly discontinued, generally after the discontinuation of many of these adverse reactions can be alleviated. If the rash is not effectively controlled, you can use some hormonal drugs or non-hormonal drugs for treatment.
In addition, in addition to life care, parents should learn to psychological conditioning.
Parents must have the right attitude, because since the child has this disease that is a fact that can not be avoided, you need to face this reality, and actively cooperate with the doctor’s treatment, the correct skin care for the affected child. After the disease is controlled and relieved, the growth and development of the child will be improved. Parents pay attention to but do not discriminate against this disease, positive and sunny attitude to face, the child will also be more positive and pleasant.
21.If the dermatitis is aggravated and there is exudation, can I still take a bath.
The clinical symptoms of atopic dermatitis are similar to those of eczema, and it is correct to say that if there is exudation, you can no longer touch water. If there is still exudate and blisters, first of all, you should do wet compress treatment to control the exudate and then use medication. The rash is a feature of skin disease treatment, astringency is one aspect of treatment, and doing wet compresses is also a good way to control exudation. Such patients should theoretically bathe regularly. However, do not use too strong alkaline soaps and bath products and do not use excessively hot water in the process of diligent bathing. Also, it is necessary to use emollients as soon as possible after bathing. For example, if a child comes back from an outside activity, it is best to quickly shower and change into clean clothes at home after entering the home, this is still beneficial to the management of the child, after all, a day outside, will be exposed to many allergy-prone substances, timely cleaning is still necessary.
22.What are the precautions in autumn and winter?
In the dry autumn and winter season, emollient use is necessary. In addition, most of the patients with atopic dermatitis are children aged 5-6 years old. Parental care and disease management should play a leading role, and mental factors may have a relevant role in the development of atopic dermatitis.
There is a correlation between children with atopic dermatitis and allergens, and not every allergen can be detected, so it is recommended to try not to have pets in the house, as cat and dog hair are allergens. Try to avoid carpets in the house, which often hide fungi. Try to avoid going to environments with more pollen. Other patients are allergic to food. First of all, it should be clear which food you are allergic to, not that you don’t eat anything once you have allergy symptoms. For example, every time you drink milk, your atopic dermatitis worsens. This time you drink milk, your condition worsens, and after you stop drinking milk for a while, the next time you drink milk, your condition worsens again. This is the time to consider whether milk is an allergen and whether you need to drink less milk or even avoid it. If the last time you drank milk, you had a serious attack, but this time you don’t have any symptoms, it may not be related to milk, but there may be a connection between the last attack and other factors.
23.What should I pay attention to in my daily life at home for children with atopic dermatitis?
Children with atopic dermatitis should not keep pets at home, try not to plant flowers, do not use carpets, these children are also allergic to some dolls and other plush products. There are also things like going out and bathing, which are also important aspects of care, and of course the care of the family is also an important aspect for the patient. We often encounter parents who come to the hospital complaining that the doctors do not have effective treatment methods. The parents’ care and management of the child also play a very important leading role.
24. Don’t believe in prescriptions for atopic dermatitis
First of all, children with atopic dermatitis should be given as much care as possible. Second, it is important to provide reasonable medication based on the appropriate diagnosis. These patients often have the behavior of seeking medical help in a hurry and try not to look for the so-called prescriptions or special drugs. Because so far, we in the more developed era no one can master a prescription can cure a disease, this is a misconception among patients in the treatment.