What is it and what treatments are recommended.
Atopic dermatitis (AD) is a chronic inflammatory skin disease with intense itch, redness and dryness.
It affects 5-20% of children and 1-3% of adults. In 60% of cases, the disease occurs in the first two years of life.
At paediatric age, both genders are equally affected, while females are more affected in adulthood.
Literature indicates a higher incidence of the disease in Northern Europe, Australia, Japan and, conversely, lower incidence in Central and Eastern Europe and in Asian countries.
Noteworthily, some countries show a turnaround in the incidence patterns, with DA in adults increased by 2-3 times in the last 30 years in industrialised countries. Hypotheses speak of a possible influence of factors like food, climate and pollution.
How does it show?
Atopic Dermatitis is not a contagious disease. It is defined as "chronic" because it alternates acute phases to periods when the skin improves and lesions tend to heal.
In general terms, the disease shows according to a seasonal pattern, where atopic dermatitis tends to get worse with the cold, dry winter weather, while it benefits from the summer heat. Proper sun exposure may, in fact, lead to improvement.
The skin lesions in AD show with a typical distribution that varies according to age.
Clinically, phases can be defined according to the age of the patient and the distribution of lesions:
- Infant or early childhood phase: from 4 months up to 2 years of age, usually affects the legs, the cheeks and the scalp
- Child phase: from 2 to 10 years of age. Shows in the inner elbows and the back of the knees (extensor regions)
- Adolescent or adult phase: after 10 years of age. Shows in the face, especially in the eyelids, the perioral area, the neck and the nape.
The most important symptoms of AD are dry skin and intense pruritus, which leads to an uncontrollable need to scratch that triggers a vicious circle because it causes more damage and the risk of secondary infections and skin thickening.
Skin affected by atopic dermatitis shows a strong alteration of the epidermal barrier, which results in xerosis, that is severe dryness and increased permeability - this makes skin more irritable and sensitive to allergens. In addition, recent literature has highlighted changes to the cutaneous bacterial flora, which makes it easier for pathogenic bacteria such as Staphylococcus aureus to colonise skin - this can lead to infections and worsen atopic dermatitis symptoms.
What are the causes of atopic dermatitis?
The causes of atopic dermatitis are hereditary-genetic factors and immunological factors, such as food allergies or contact allergies. Many times, AD is associated with asthma and / or allergic rhino-conjunctivitis.
The diagnosis of this disease is not always easy. Skin symptoms are, in fact, similar to other diseases. Even today, there are no specific atopic dermatitis tests, thus guidelines have been developed to allow physicians to make a clinical diagnosis.
Atopic dermatitis severity scale is defined by the SCORAD, that is the Scoring Atopic Dermatitis, a system developed by a team of AD experts (European Task Force on Atopic Dermatitis, 1993).
This system considers both objective signs, like severity and extension of skin lesions, and subjective signs, such as itch and loss of sleep.
According to the SCORAD, Dermatitis Atopic can be classified as:
- SLIGHT with SCORAD < 15
- MODERATE with SCORAD between 15 and 40
- SEVERE with SCORAD > 40.
Atopic dermatitis has a strong impact on the quality of life of the child patient and, consequently, on the whole family, because it means restless sleep and difficulties in performing school activities and play. In adults, it can negatively affect work and socialising.
Dermo-cosmetic treatments for Atopic Dermatitis
Besides the drug therapy for the acute phases of the disease, which is based on keeping inflammation under control, the application of emollient and moisturising cosmetics can indeed have a therapeutical added value. Experts define this as a "basic therapy", that is cosmetic formulations that work to restore and preserve the stratum corneum barrier function, thereby improving chronic dryness, helping to soothe itch and preventing complications. The literature has also highlighted that the use of moisturisers allows to prevent disease recurrence and, consequently, reduce the use of topical corticosteroids.
Cosmetic “basic therapy” treatments should generally be applied on a daily basis, or even more frequently, depending on the degree of severity of xerosis, and should also take climatic conditions into account.
The most suitable treatments for "basic therapy" are emulsions, that is systems consisting of an aqueous phase, hydrophilic ingredients and components of the fatty phase. Depending on the amount and emollient properties of these components, products can be fine-tuned to be more suitable for use in the hotter season or be more indicated for the colder season.
Properly cleansing skin will also help to keep atopic dermatitis at bay. Cleansing skin must provide effective cleansing to rebalance skin flora and keep pathogenic bacteria under control, whilst be delicate and with a slightly acidic pH at the same time. Cleansers must therefore include mild surfactants, either amphoteric or non-ionic, which make little foam but have the advantage of not being harsh to skin and also being suitable for washing hair and the scalp gently.
Bathing, as opposed to showering, may preserve skin a little better. However, both baths and showers should be quick and done with lukewarm water. After washing, pat-dry skin instead of rubbing.
In order to avoid irritant and allergic contact dermatitis, which can frequently occur with atopic dermatitis due to the increased skin permeability, it is important to use cosmetic products made with only a few ingredients and that are well tolerated by skin, thus excluding ingredients such as perfume and preservatives because these are well known allergens (skin sensitisers).
Practical advice for managing Atopic Dermatitis patients
At home: Do not overheat domestic environments, change the air often, avoid using carpets and cigarette smoke, in addition to vacuum cleaning often to prevent other potential airborne allergens (dust, mites).
Clothing: do not use wool or synthetic fabric clothes, but rather choose cotton clothing. With Atopic Dermatitis in children, avoid covering the child too much, because sweat worsens itch. Normal laundry detergents can be used, just make sure laundry has been well rinsed. Do not hang laundry outside to dry in spring.
Sports: in general terms, sports activities may give more hassles than benefits, because of the sweating involved, which can exacerbate skin discomfort. It is much better to do sports moderately and to shower immediately after physical activity. The chlorine in swimming pools may increase the skin irritation, thus worsen the itch. In addition to washing with lukewarm water after swimming, it may be useful to apply a barrier-forming product before swimming.
Sun exposure: provided that we put on proper sun protection, sun exposure can improve the overall condition of skin. After bathing in the sea, always take a shower to remove salty seawater residues.
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All BioNike products of the TRIDERM, DEFENCE and PROXERA ranges are developed to reduce the risks of intolerance and are suitable for sensitive skin. Such products are, in fact nickel-tested, preservatives-free, perfume-free (or having an allergen-free perfume), gluten-free and manufactured with carefully selected and controlled ingredients.
In any case, we recommend that you consult your pharmacist and/or dermatologist, who will be able to recommend what is best for your skin.
Did you know it?
For the cleansing and treatment of atopic dermatitis skin, BioNike has developed the TRIDERM ALFA range of products specific for hyperreactive and atopy-prone skin. It is based on basic formulations that include just a few, safe ingredients, free from potential irritants / allergens.
TRIDERM ALFA CLEANSING BASE is a cleansing product suitable for washing both skin of the whole body and hair, TRIDERM ALFA LIGHT CREAM BASE and TRIDERM ALFA RICH CREAM BASE are ideal as daily moisturising and emollient treatments in the warmer season and in the colder season, respectively.
TRIDERM ALFA OINTMENT BASE has been designed to protect against redness and cracking, whilst soothing skin and providing a protective barrier. With a 25% of zinc oxide and 25% of corn starch, it is useful it i salso useful to keep any exudate under control.
Finally, TRIDERM ALFA FLUID BASEis a fluid emulsion to rebalance skin in the hot weather especially, suitable for application over the body. In addition, it can be used as a base for developing compound preparations.