Atopic dermatitis tips

Atopic dermatitis is a chronic, relapsing, inflammatory skin disease that is considered a systemic disease because patients often have other atopic diseases such as allergic rhinitis and asthma [1].

1. Etiology and Pathogenesis

Since atopic dermatitis is a chronic, recurrent disease, its skin lesions are polymorphic. The onset of atopic dermatitis is closely related to genetic and environmental factors. A history of allergic diseases in parents and other family members is the strongest risk factor for the disease. Genetic factors mainly affect the skin barrier function and immune balance [1].

2. Clinical manifestations

Atopic dermatitis is a chronic disease with a variety of clinical manifestations. The most basic features are dry skin, chronic eczematous skin lesions, and obvious itching. It usually first occurs in infancy, with half of cases occurring before the age of one year. In infancy, it is more common on the head, face, and neck, with obvious itching, which has a serious impact on the lives of children and other family members. In my country, the severity of atopic dermatitis in children is mostly mild, followed by moderate, and less severe [2]. The specific age stages and clinical manifestations are shown in Table 1.

Table 1. Stages and clinical manifestations of atopic dermatitis[1]

||||

III. Treatment and Management

1. Prevention and health education

Since atopic dermatitis is a chronic recurrent disease that requires long-term treatment, it is recommended to bathe properly and avoid various mechanical, chemical, and bleaching agents that may aggravate the condition. If irritated, it should be treated promptly and the wound surface should be cared for with moisturizing lotions [3].

2. Drug treatment of atopic dermatitis

Topical glucocorticoids are the first-line treatment for current drug treatment. Before use, glucocorticoid preparations of different dosage forms and strengths should be selected according to the severity of skin lesions. For example, 0.05% halometasone cream is the most commonly used topical potent glucocorticoid in China. It is suitable for moderate to severe, hypertrophic skin lesions. The base material is mainly vaseline, which has a moisturizing effect. For children with hypertrophic skin lesions, avoid long-term continuous use of halometasone cream. Children over 2 years old should generally not use it for more than 2-3 weeks. Pregnant and lactating women may experience teratogenic effects when using it, so contraceptive measures should be taken [1].

Itch is the main symptom of atopic dermatitis, which can cause sleep disorders and even physical and mental problems. It can be treated with the antihistamine cetirizine combined with other drugs. Immunosuppressants can also be used to treat itching caused by inflammatory skin diseases. Cyclosporine A is a fast-acting immunosuppressant for the treatment of atopic dermatitis. It is a calcineurin inhibitor that can exert an immunosuppressive effect by inhibiting the activation of T lymphocytes. It is widely used in patients with severe atopic dermatitis who are ineffective with conventional local treatments [4].

【References】

[1] Immunology Group of the Chinese Society of Dermatology and Venereology, Atopic Dermatitis Collaborative Research Center. Chinese Guidelines for the Diagnosis and Treatment of Atopic Dermatitis (2020 Edition)[J]. Chinese Journal of Dermatology, 2020, 53(2):81-88.

[2] Luo Yangyang, Li Keyao, Liu Xiangyu. Clinical analysis of 145 cases of childhood atopic dermatitis[J]. Journal of Practical Dermatology, 2020, 13(1): 25-27.

[3] He Chunyan, Qin Yeping. Characteristics of hand skin and countermeasures for hand health problems[J]. Chinese Journal of Aesthetic Medicine, 2021, 30(1): 172-176.

[4] Wang Li, Chen Zilan, Chen Qingdong. Observation on the efficacy of cyclosporine A in the treatment of atopic dermatitis[J]. Chinese Journal of Modern Medicine, 2021, 31(15):99-102.