Atopic dermatitis (Reading & Sharing)

Atopic dermatitis is a common inflammatory skin disease that mostly occurs in children and E (IgE) is secreted in response to environmental or food allergens. Typically dermatitis and eczema are used interchangeably when the patient has an acute flare-up. The condition is non-contagious and is characterized by dry, itchy skin, but in chronic or severe cases it can cause thick plaques, slightly raised, watery exudate to form or become infected which can affect the patient’s quality of life. So, therefore, because eczema is a common skin disorder seen in primary care the discussion will include the incidence, prevalence of the disease and pathophysiology from the primary provider perspective. As well as the physical assessment and exam, treatment plan, patient education, follow up and evaluation.

Incidence/Prevalence

Atopic eczema is a prevalent inflammatory skin disorder its prevalence appears to vary across the world as noted in key international epidemiological studies. Such variation has been found in both children and adults and points to the likely importance of environmental risk factors. Also, atopic eczema has been shown to cluster in families, and there is growing evidence that it is a herald condition in many people who go on to develop allergic problems affecting other organ systems such as food allergies. The incidence of the immunological disorders and mutation in the filaggrin gene is the major causes. In some cases, the incidence of infection with these inflammatory lesions reinforces the significance of treatment such as emollients, corticosteroids and calcineurin inhibitors (Tavakol & Roshanak, 2015).

Pathophysiology

The impairment of the skin’s barrier function leads to an increased sensitization to cutaneous antigens and is a significant factor in the pathophysiology. Some studies have shown that there is a genetic link to chromosome 1q21. The gene is involved in the formation of the epidermal layer the mutation in the filaggrin gene which encodes a protein needed for the differentiation of the epidermis has been identified as the impaired barrier function which increases exposure and sensitization to the cutaneous antigen seen in atopic dermatitis patients. In the acute phase of atopic dermatitis, the interleukins lead to increase production of IgE and eosinophilia but if it is persistent inflammation and scratching it can eventually lead to chronic atopic dermatitis, with thick, lichenified skin (Epocrates, 2017).

Physical Assessment/ Exam/ Treatment

Eczema is diagnosed by the appearance and location of the rash as well as an individual or family history of allergies, including food allergies, hay fever or asthma supports the diagnosis of eczema. There is no laboratory test for diagnosing, but some dermatologist will initiate a skin tests scratch, patch test or intradermal injections to identify the allergens if no reaction develops in the next few days then another allergen is tested. But to check the level of immunoglobulin E (IgE), a blood test is done however with rare cases a biopsy is done to rule out other diseases (Alic, & Turner, 2011). The first line of treatment is emollients and topical corticosteroids, but if there is no response topical calcineurin inhibitors, phototherapy, and immunosuppressive agents are utilized. However, if an infection is suspected or colonization, oral antibiotics are used and antihistamine or doxepin will be used for persistent pruritus symptoms (Epocrates, 2017).

Follow up/Evaluation

Atopic dermatitis is a chronic disease with a different course. Approximately 60% of children will have symptom resolution as they enter puberty, but relapse may occur in 50%. Although it can be difficult to predict the course of this disease, specific factors place patients at risk. It found that disease severity and early atopic sensitization were associated with a poorer prognosis. Atopic sensitization was quantified by measuring particular IgE levels, and although there was a strong association between IgE level and disease severity, no prognostic cutoff values have been established.

Patient Education

All patients should be educated on proper skin care, bathing hygiene and the avoidance of trigger factors, for example, house dust mites, irritants, and dietary allergens. Also, they must understand that atopic dermatitis is a chronic disease and that emollients are required to maintain the skin’s barrier function even when their condition is well controlled. When a child is diagnosed with this disorder, it is essential to give the parent written instructions.  Such as keeping the Childs fingernails cut short or applying mitts to hands to prevent damage or irritation to the skin and with infants it is good to breastfeed the infants that are at high risk for eczema (Schmitt, 2013).

References:

Afshari, J., Salari, R., & Yousefi, M. (2016). Atopic dermatitis and the therapeutic methods: A literature review. Mashhad University of Medical Sciences, 3(4), 158 – 162.

Atopic dermatitis treatment approach – Epocrates Online (premium). (2017). Retrieved from https://online.epocrates.com/dx/indexprint?entire=false&lid=87&sid=41&activeTab=9

Schmitt, D. (2013). Eczema (atopic dermatitis). CRS – Pediatric Advisor, 1 – 1.