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Few diseases in dermatology raise as many questions as atopic dermatitis, in addition to impairing the quality of life of patients and their families. It is a frequent, chronic disease associated with intense itching. It can appear at any age but it is more frequent to appear before the age of 5 years. It is sometimes associated with a tendency to suffer from asthma, rhinitis and allergies. The cause is unknown.

What are the lesions in atopic dermatitis like?

In younger children, facial involvement is frequent and in areas of extension in the form of “red pimples” or exudation (lesions that shed clear or slightly yellowish scanty fluid). With age the lesions become more “dry”, rough or thickened and predominantly in flexion areas.

Questions raised about atopic dermatitis

After these general outlines, I would like to provide practical answers to questions that frequently arise in the practice. In any case, it is a complex disease and very variable from one patient to another, so I recommend that you consult with your dermatologist if you have any doubts or concerns.

Doctor… what is the reason for this?

As I mentioned before, it is not known exactly. Genetic, environmental and immune factors are involved, but it is still difficult to translate this knowledge into concrete treatment measures.

And will it last a lifetime?

Although the prognosis is unpredictable in each case, atopic dermatitis tends to disappear with time and most children are free of lesions by puberty.

How is it diagnosed? My son hasn’t been tested!!!!

The diagnosis of atopic dermatitis is based on clinical manifestations (seen by the dermatologist when observing the patient) and exclusion of other diseases that may be similar. There are no laboratory tests to diagnose atopic dermatitis. A food allergy test is not necessary, but it may be considered in certain cases.

I have been told that diet can improve….

The relationship between atopy and diet is not clear. There is consensus in avoiding very restrictive diets if there is no reason (allergies, intolerances…). It seems that diets rich in polyunsaturated fatty acids should be avoided in favor of diets rich in antioxidants. Prebiotics, probiotics and synbiotics have not been proven to act on dermatitis.

Breastfeeding protects against atopic dermatitis…

Well, things are not clear either. There is no conclusive data on whether it is better to prolong or avoid it… so we recommend that children with atopic dermatitis receive the same breastfeeding guidelines as other children.

Can I do anything to improve my dermatitis?

Absolutely yes! It is not uncommon to observe patients who do not have good control, yet do not perform simple tasks that contribute to improving it. We recommend the use of specific hygiene products, avoiding prolonged showers or baths and we recommend moisturizing the entire skin at least once a day.

My neighbor told me that corticosteroid creams are bad….

ALL drugs have adverse effects, and when we prescribe them we are assessing the benefit-risk (and not giving a drug can also have its risk…). Topical corticosteroids are FIRST LINE TREATMENT in dermatitis. Your dermatologist will tell you which corticosteroid to apply and how to apply it. We often find patients undertreated (with all that this entails: skin lesions, itching, scratching, superinfection, sleep disturbance…) for fear of corticosteroid use.

Doctor, but isn’t there anything else?

Other topical drugs have been available for some years: tacrolimus and pimecrolimus. They are effective and have been shown to be safe in the medium term. Further studies and time are needed to assess long-term safety. In case of severe atopic dermatitis, very extensive, which are not controlled with the above, we have at our disposal phototherapy (controlled and regulated administration of ultraviolet radiation, generally ultraviolet b) and oral medication. This includes oral corticosteroids and other drugs that can be considered for the medium or long term, such as cyclosporine or methotrexate. They are not free of adverse effects so their indication should always be individualized and carefully weigh benefit and risk.

Dr. Beatriz Fleta Asin