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Atopic Dermatitis

Atopic Dermatitis is a skin condition characterized by dry, flaky, itchy skin. It is due to immune system dysregulation. It is commonly seen in families with a history of hay fever, rhinitis, eczema, and allergies. Allergies have not been seen to influence atopic dermatitis; however, there are few allergens that can cause the immune response seen in atopic dermatitis. Patients with both allergies and atopic dermatitis may need to see both an allergist and a dermatologist to appropriately treat both diseases.

 

Atopic dermatitis can range from mild to severe. Patients typically see thickened, dry skin on the back of the knees, elbows, or on the face. The itching from atopic dermatitis can disrupt sleep and impair daily functioning. Infants with atopic dermatitis are more likely to present with dry, flaking skin on their cheeks and face as well as the trunk of their body. Eczema comes in many different types. There is a type of atopic dermatitis called nummular eczema where patients present with coin-shaped lesions that are either wet appears or dry like traditional atopic dermatitis. It is often confused as being a form of tinea, but is more common than tinea infections. It is prevalent on the lower legs, trunk, and arms. In the elderly population a variant of atopic dermatitis called asteatotic eczema is common. This type of eczema appears as a dry, cracked riverbed appearance. It is typically seen on the lower legs, due to the natural process of drying skin seen in aging. Patients with darker skin can have a type of atopic dermatitis called follicular eczema. Which is an eczema of the hair follicle looking like papules on the patient’s skin. This can be linked to keratosis pilaris.

How is it treated?

Atopic dermatitis treatment is based on the severity of the disease. Treatment options range from mild topical steroids all the way to biologics like Dupixent. Topical steroids can be tailored to the severity of the eczema. Severe eczematous scales may require a stronger topical steroid like clobetasol. Clobetasol may also be used for hand and foot eczema, where the skin is thicker. Topical steroids are typically avoided on the face other than low strength steroids like hydrocortisone. A stronger topical steroid may be needed on the face for conditions like seborrheic dermatitis, but are only used for a short period of time. For patients who fail to have resolution of their eczema from topical steroids, oral medications like methotrexate, cyclosporine, and cellcept may be needed. If patients do not have full resolution with oral medications the biologic Dupixent is used. Dupixent is now approved for patients age 6 and up.

If you or your child have any of these symptoms, please come and see us at Moksha Derm. We would love to help you get back to looking and feeling your best!