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About Atopic Dermatitis
Atopic dermatitis is also called
eczema, but in fact there are several types of eczema. It is
a stubborn itchy rash of unknown cause, which occurs in people
with sensitive skin.
Atopic dermatitis affects about
15 percent of infants and small children, but it usually clears
before adulthood. It may reappear at any time however.
Eczema is probably the result of
an inborn defect of immune cells that tends to run in families;
other family members often have asthma or hay fever. Atopic
eczema is not contagious and does not affect one's general
health. The skin is usually dry and easily irritated by soap,
detergents and woollen clothing. Eczema may be aggravated by hot
weather and a wide variety of environmental factors both at home
and at work. These include dust, cats, emotional stress, and
rarely foods. Teenagers and adults with eczema should choose
their occupation carefully, in particular avoiding careers which
involve wet work or handling detergents and solvents.
Atopic eczema rarely develops in
babies before the age of four months (infantile seborrhoeic
eczema occurs before this). The face is often affected first,
then the hands and feet. Sometimes dry red patches appear all
over the body.
In older children the skin folds
are most often affected, especially the elbow creases and behind
the knees. In adults the face and hands are more likely to be
Sometimes there is secondary
infection with staphylococcus aureus bacteria (impetigo).
The result is oozing, crusting, with pustules, and the eczema
may suddenly get worse. Infection with Herpes simplex
(the cold sore virus) may cause a severe blistering rash.
Infected acute eczema
Chronic eczema resulting in scratch
Urticaria (reaction to medication)
Urticaria refers to a group of
disorders in which wealing occurs in the skin. The release of
chemicals such as histamine causes small blood vessels to leak
and results in tissue swelling. The weal's can be a few
millimetres or several centimetres in diameter, coloured white
or red, often surrounded by a red flare, and frequently itchy.
Each weal may last a few minutes or several hours, and may
change shape. Weals may be round, or form rings, a map-like
pattern, or giant patches.
The surface weals may be accompanied by deeper swelling of
eyelids, lips, hands and elsewhere. The swelling is called
angioedema. Angioedema may occur with or without urticarial
Generalized urticaria (hives) is
often classified according to how long it's been present.
- Acute urticaria is of recent
onset (hours, days or a few weeks).
- Chronic urticaria has been
persistent for several months or years.
Urticaria may not be present all
the time. Some find it more noticeable at certain times of day,
or when they are warm or emotionally upset.
is sometimes due to allergy. Allergy depends on previous
exposure to the material, and the development of an immune
reaction to it. A protein called IgE is involved.
The cause of an allergy may be:
- Medicine: most often an
antibiotic, but many other drugs have been reported.
- Food: tiny amounts of fish,
eggs, nuts or chocolate.
- Bee or wasp stings.
Most allergies are mild, but
very allergic individuals may develop serious anaphylactic
shock within a few minutes of exposure. The most frequent
causes are antibiotic injections, bee stings or ingestion of
peanuts. anaphylaxis results in urticaria, a tight chest,
wheezing (bronchospasm), faintness and collapse. Medical
attention must be sought urgently. A subcutaneous adrenaline
injection will usually be given: those prone to anaphylaxis
should carry an emergency supply (an EpiPen).
Most cases of urticaria are not
due to allergy histamine and other vasoactive chemicals can be
released into the skin for many reasons. Urticaria can occur the
first time that a person is exposed to the material.
Some non-allergic causes of
- Infection, including
sinusitis, helicobacter (a cause of stomach ulcers), dental
abscess and candida (thrush).
- Serum sickness, due to blood
transfusion, viral infection or medicines (e.g. Ceclor);
urticaria is accompanied by fever, swollen lymph glands,
painful joints and nausea.
- Non-allergic reactions to
medicines (especially morphine, codeine, quinine, aspirin and
other non-steroidal anti-inflammatory drugs).
- Non-allergic recurrent
angioedema, also provoked by medicines (particularly ACE
inhibitors such as captopril, quinapril, enalapril and
- Non-allergic food reactions
(most often from salicylates in fruit, azo dye food colouring,
benzoate preservatives and other food additives).
is most often due to autoimmune disease (allergy to one's self),
and may be associated with other autoimmune conditions such as
thyroid disease. Circulating 'anti-idiotypic' antibodies cause
excessive release of histamine.
Recurrent angioedema without
urticaria may be due to C1 esterase deficiency (the protein C1
INH is missing or abnormal); there is often a family history of
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| What to avoid
No permanent cure is possible,
although with time atopic eczema usually improves. Most people
are able to live comfortably with their skin condition with the
- Keep cool: have tepid baths,
wear loose cotton clothing, and keep bedding to a minimum
- Avoid direct skin contact
with rough fibres, particularly wool
- Avoid dusty conditions
- Use gloves when handling
chemicals, solvents and detergents
- Choose cosmetics carefully;
make-ups, perfumes and creams can all irritate
- Bathe without soap: use water
alone or add a soap-free cleanser
Allergic reactions can occur to
materials touched, inhaled or ingested. Responsible compounds
(detected by prick tests) include house dust mite, moulds, grass
pollens and animal danders, such as cats and horses. The home,
especially the bedroom, should be kept as free of dust as
possible. It is controversial whether it's better not to have
any pets or whether regular exposure to them reduces the
Most individuals will not helped
by special diets (eg. dairy-free etc.). It is particularly
important that growing children have a broad range of
nutritional foods. But, if a particular substance consistently
aggravates the skin problem, it is reasonable to avoid it for a
while. Professional advice can be obtained from a registered
dietician. Children are seldom allergic to dairy products and
eggs although occasionally they may aggravate their eczema or
result in hives, vomiting, diarrhoea, nasal stuffiness or
wheezing. Others have flare-ups with wheat, nuts, food additives
or other items. Fortunately, most affected children grow out of
their food intolerance.
Other subjects may have contact
allergic dermatitis, which can be detected by patch tests. The
commonest contact allergy is to nickel (affecting about 10
percent of women). Other common contact allergies are rubber,
perfumes, preservatives and certain plants.
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| Risk Indicator
Atopic dermatitis is not normally a
dangerous condition. It can however vary in severity from one
individual to another, in certain instances, requiring
hospitalisation. Always consult your Doctor if you are in doubt
as to symptoms or severity.
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