By The Nation
Aiming to raise awareness among the public about the condition as World Atopic Dermatitis Day was celebrated on September 14, Professor Kanokvalai Kulthanan, MD noted that atopic dermatitis is a chronic inflammation of the skin that can go into remission then flare up again.
Symptoms of atopic dermatitis can be divided into three stages, said Kanokvalai, who is the chairwoman of the Department of Dermatology, Faculty of Medicine, Siriraj Hospital at Mahidol University. In the acute stage, patients develop red, swollen itchy rash accompanied by papules or bumps that leak pus. The subacute stage features a rash and papules, itching and scales. Some patients may develop suppurative bumps that do not leak pus.
During the chronic stage, the rash appears pale red or brown in colour. There may be hives, itching, scales and visible skin creases. Locations of the rash are different depending on the patient’s age. Infants usually develop inflammation on the face, neck and the outside of the limbs as these are the areas that the babies rub against the pillow or mattress to alleviate itchiness.
Caused by allergic reaction and the combination of other factors that make the skin dry, easily irritated and developing redness or a rash on different body parts, atopic dermatitis generally appears in children, but it can affect anyone at any age. In Thailand, it occurs in 10 to 20 per cent of children, whereas adults are less affected.
“Approximately 50 per cent of patients develop symptoms of atopic dermatitis in the first year of life, and 85 per cent are children age five or younger. The symptoms are normally chronic and flare periodically. As the patients get older, symptoms tend to improve. Roughly 40 to 50 per cent of patients are in remission when they reach age 10,” Kanokvalai said. “However, some children have to live with atopic dermatitis until adulthood. Some patients have atopic dermatitis when they are adults. Diagnosis is commonly based on clinical features. Skin tests, blood tests for allergens or food allergy tests are not useful for diagnosis. Doctors may consider these tests or other laboratory tests for certain patients to determine stimulants only when the symptoms do not improve or become more severe after having received appropriate treatment.
Atopic dermatitis in older children and adults often appears at the folds of the arms and legs, and the neck. Some people may develop rash over the entire body. Nasal allergies, eye allergies and asthma may coexist in certain patients. Other skin conditions that may develop include pityriasis alba, dark circles under the eyes, creases under the eyes, cheilitis, hyper-linear palms, ingrown hair, gooseflesh skin and dry scales on the shin.
It is not yet known what causes atopic dermatitis. Hereditary traits may be involved since the majority of patients have a history of allergy in the family, perhaps hay fever, coughing, sneezing, and asthma with or without atopic dermatitis.
Those without history of allergy in the family can also be affected due to undiagnosed genetic disorders. An important factor that often triggers atopic dermatitis is the sufferer’s environment, such as food, dust mites, irritants or allergens. The skin of affected people is sensitive to the environment, both in terms of the physical environment such as it being too hot or cold weather, chemical irritants, or living organisms such as insects and bacteria.
The objectives of treatment for atopic dermatitis are to control the symptoms, prevent flare-ups, and maintain remission for as long as possible until the condition disappears. Patients are recommended to avoid all irritants and triggers, moisturise the skin with emollient, such as using skin lotion or body cream immediately after a bath to prevent dryness, and to refrain from taking a bath or shower too often as the skin may become drier.
For treatment, medicated topical creams and ointments are applied to control skin inflammation. Once the condition is improved, patients may reduce the frequency of application or stop medication. If the rash is severe or covers a large area, oral medication may be necessary. Injection is another option currently available for treatment. However, doctors normally apply this option to patients whose symptoms are medium to severe and do not respond to other methods. It is not recommended without supervision of dermatologists.
“If you suspect you are having atopic dermatitis, please see a dermatologist for appropriate diagnosis and treatment. This chronic disease can have psychological impact and ruin the quality of life of patients and their family. It can have impacts on sleep, study, work, confidence and socialization,” said Kanokvalai. “Some patients choose clothing that covers large parts of the body out of embarrassment. This can affect daily life. If the patients come to see dermatologists and receive appropriate treatment, the condition can be controlled. As a result, the quality of life of relating persons is improved. They will be able to live a normal life.”