Atopic DermatitisAD (Atopic Dermatitis) is a very common, chronic, relapsing and very itchy skin disorder - affecting over 10% of children. ONSET: Most cases (90%) begin within the first 5 years of life, often slowly improving over the years. Only 10% of AD first appears in adulthood (ie: without a childhood history of such). DISTRIBUTION: The location of the lesions vary widely but "classic patterns" are as follows: Infants - face, scalp, extensor surfaces (ie: wrists, knees, elbows) and on the lower buttocks. Older children/adults - eyelids, hands, flexural folds (ie: inner wrists, elbow creases and space behind the knees). NICKNAME: Eczema just means skin inflammation - however AD is the most common form of Eczema so the words are often used interchangeably. FACTOID: They say that AD is "the itch that rashes." In other words, affected skin itches like crazy due to the disease, but it doesn't rash until it is scratched. CAUSE: I like to think of it as "abnormal genetics" (ie: genes go awry so that there is a genetic tendency for immune cells to damage one's own skin). The "tight junctions" are damaged between the top layer of skin cells (ie: keratinocytes) so that water can be lost easier and the skin becomes "dehydrated." ITCH/SCRATCH CYCLE: The dry skin itches terribly and scratching only worsens the micro-cracks leading even more water loss. This continual itch/scratch cycle can lead to chronic thickening, scaling, "alligator skin" like damage. COMPLICATIONS: Bacteria, viruses, fungi/yeast are usually can not enter the into healthy skin. However the can slip into micro-cracked damaged AD skin and colonize or infect the skin - causing the AD flare up even worse. EXACERBATORS: Irritants and allergens can also enter damaged skin easier -- result in AD flares or chronic lesions resistant to treatment. Stress, heat, dry air, soap/detergent, frequent wetting/drying (ie: evaporation) and a host of other triggers can worsen AD. COMORBIDITIES: Stress can trigger AD. Likewise, AD can cause chronic stress, leading to poor sleep, poor mood, poor school/work performance, increased anxiety, difficulty focusing, etc. Asthma &/or Allergic Rhinitis is seen in about 50% of those with AD; however, many have no known contact, airborne or food allergies at all. TREATMENT: A Soak & Seal "Skin-Hydration" Regimen is Key (see handout). Avoiding Irritants, Allergens, Stress and using Topical Medications and Antimicrobial Measures are also part of the care plan. | Allergic Contact DermatitisACD (Allergic Contact Dermatitis) is also very common itchy type of eczema. CAUSE: ACD is due to a "delayed" immunologic reaction to an allergen that penetrates into the skin. Immune cells in the skin abnormally see "an allergen" linked to surface the affected skin cells as a foreign threat - so they destroy the affected skin cells. This leads to inflammation, swelling, itching and rash (aka - dermatitis). MIMICKER: ICD (Irritant Contact Dermatitis) is due to a physical things that damage the skin (ie: detergents, chemicals, solvents, alcohols, over washing and improper drying, temperature extremes, etc). The Keratinocytes are damaged and the skin barrier becomes cracked, leading to less protection from future irritants - so the cycle can be hard to break. ALLERGENS: ACD, unlike ICD, is an actual delayed allergic (abnormal immune) reaction. Common allergens are plant oils (ie: poison ivy, ragweed, tulip bulbs, pine/wood saps), Perfumes/Fragrances, Metals (ie: nickel, gold, cobalt...), Colophony (rosin), Rubber Chemicals, Plastic Resins, Dyes, Preservatives, and various Topical Medications (ie: neomycin, bacitracin, benzocaine, benadryl creams or ointments). PATCH TESTING: These chemicals can be placed on patches and left on the skin for 2-3 days and then read over the next several days to determine which, if any, is possibly causing ACD. More info on this to follow, but until I can post more: check out a great resource on ACD and Patch Testing at truetest.com. |