Information on Eczema

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Atopic Dermatitis (AD), also known as atopic eczema, is a chronic, non-contagious inflammatory skin condition characterized by recurrent episodes of intense itching and periods of improvement and flare-ups. It primarily affects small children but can also manifest in adults.

• Appearance and Symptoms: Individuals with AD exhibit red or brownish patches of skin that may be dry, cracked, or scaly. Itchiness is particularly pronounced at night. In infants, eczema typically appears as small bumps on the cheeks, while older children and adults tend to develop rashes on knees, elbows (often in joint folds), the back of hands, or the scalp.
• Infections and Complications: AD patients are at a higher risk of developing secondary bacterial and viral skin infections. Signs such as crusting, purulent exudates (pus), and pustules may be present with localized infections or active dermatitis.
• Prevalence: New cases of AD are on the rise, affecting approximately 10% to 20% of children worldwide and up to 3% of adults. Roughly 60% of AD cases manifest within the first year of life. About 75% of children with early-onset AD experience spontaneous remission before adolescence.
• Causes: While the precise cause of AD remains unclear, a combination of genetic and environmental factors is believed to contribute to abnormalities in both the epidermis (outer skin layer) and the immune system. Triggers for AD can include allergens, stress, dry skin, and infections.
• Detection: AD is characterized by inflamed, intensely itchy skin, particularly severe at night. Pruritus (itching) is a prominent symptom, often leading to scratching until bleeding occurs. Other clinical criteria include eczematous appearance, red or brownish patches, and dry, cracked, or scaly skin.
• Types: AD can be categorized into two types - intrinsic (non-allergic) and extrinsic (allergic). Intrinsic AD, more common in children, is characterized by normal IgE levels and a lack of sensitization to allergens. Extrinsic AD, more prevalent in adults, involves increased IgE levels and sensitization to specific allergens.
• Associated Conditions: AD is often linked with other allergic conditions like asthma, allergic rhinitis, and food allergies. Approximately 30% of children with AD develop asthma, and 35% develop allergic rhinitis.
• Severity: AD severity is assessed through clinical measures, including tools like the Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), and the Physician-Investigator Global Assessment (PGA or IGA). Itching intensity, affected area count, and clinical course also inform severity assessment.
• Quality of Life Impact: AD not only has physical effects but also emotional consequences. It can lead to feelings of being singled out, especially in children, potentially limiting activities like sports. Family life may also be affected due to medical visits, treatments, and sleep disruptions.
• Prevention: While AD can't be entirely prevented, there are preventive measures. Primary prevention focuses on reducing the risk of developing AD in predisposed children. This can involve breastfeeding, introducing solid foods after 4-6 months, probiotic use, and avoiding certain environmental factors.
• Treatment: There's no complete cure for AD, but numerous effective treatments are available. Flare-ups can be managed with topical steroids, non-steroidal creams, and phototherapy. Systemic drugs are also used for control. Establishing a regular care routine, including gentle cleansing and moisturizing, is crucial in managing AD.

Managing AD involves a multifaceted approach, combining medical treatment, lifestyle adjustments, and psychological support.