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April and Skin Allergy

Those who have atopic dermatitis may experience flare up of the skin inflammation. Let’s get to better known atopic dermatitis to avoid the summer flare up of the disease.

Approaching the summer month of April when the weather is muggy, those who have atopic dermatitis may experience flare up of the skin inflammation. Let’s get to better known atopic dermatitis to avoid the summer flare up of the disease.

Atopic Dermatitis is the condition when your body adversely reacts to aeroallergens such as dust mites, cat and dog danders, grass pollen, fungus, coackroach and food allergens such as cow’s milk, soy milk, egg, wheat, and seafood leading to chronic inflammation of skin. Atopic dermatitis is common in children and adults, but is most common in infants.  In most cases, the onset of symptoms is at the age of 2 months or above with highest incidents occuring between the age of 2 months and 2 years. Symptoms usually improve with increasing age, but may persist into adolescence or adulthood. Around 13.4% of Thai children have atopic dermatitis.

Causes
The cause of atopic dermatitis is not currently known. However, the risk factors could be genetic, environment and diet. 36.1% of Thai children with atopic dermatitis also have food allergies.

Symptoms
The symptoms can be classified based on 3 age groups.

  1. Infant aged 2 months – 2 years. The symptoms include red and itchy rash with fluid-filled vesicles on the cheeks. If the vesicles burst, there will be weeping of serum that later crusted. The skin rashes may spread to other area, and in severe cases, may cover the whole body with visible scratch or abrasion marks especially in the area where infants kick or rub against the floor or mattress.
  2. Children aged 2-12 years. The lesions are often visible around neck and in the skin folds of arms and legs. If the symptoms flare up, the rash may spread to other body parts. Dry, red, and slightly scaly papules are common. There are no moist, burst fluid-filled blisters like those in infants. Itichiness is to be expected and scratching may lead to abrasions wound which are prone to secondary viral or bacterial infection.
  3. Adolescence and adulthood of age 12 years old or above. Rashes around the neck and in the creases of arms and legs, similar to those in children, are common. Rash can develop all over the body in serious cases. Patients in this age group are also prone to hand dermatitis.

Stages of Atopic Dermatitis Symptoms
There are 2 stages of the symptoms

  1. Flare-up: Atopic skin rashes are visible and spread to many body sites. The location of rashes vary by age. Secondary infection by virus or bacteria may occur.
  2. Remission: No observable atopic skin rashes over the body, but the skin may be dry and itchy.

Treatment

  1. Avoid the symptom triggers
    • Avoid exposure to known allergens. If the culprit allergens are not known, see your doctor for a blood test or skin prick test to identify them.
    • Refrain from taking a hot or warm bath/shower. Switch to mild or hypoallergenic soap but use them sparingly.
    • Avoid exposure to irritants. Use mild detergent for your laundries and make sure it is thoroughly risnsed out before wearing the clothes.
    • Wear clothes made from soft and airy fabric such as satin and Avoid fur garments.
    • Avoid exercise that leads to heavy sweating.
    • Avoid extremely hot or cold weather as it can cause dry skin.
    • Do not apply or spray alcohol or disinfectant on the rash to relieve the symptoms.
    • Keep your fingernails short to prevent recurrent bacterial or viral infections due to scratching.
    • Avoid stressful or worrisome situation.
  2. Do not scratch. Take antihistamines to relieve itchiness. The side effect of the medication includes drowsiness which is beneficial for lessening of scratching.
  3. Steroids act directly to decrease the inflammatory process of atopic dermatitis. They should only be applied to the affected skin during flare-up period; however, the medication should not be used longer than 1 week and must be under the doctor’s discretion. Two new non-steroids topical agents, tacrolimus and pimecrolimus, can be used for treatment lasting longer than 1 week.
  4. If you have secondary infection, which appears as pustules in the skin rash area, consult your doctor as you may need to take oral or apply topical antibiotics.

Prevention and Treatment of Dry Skin

  1. Apply moisturizer or lotion right away or within 3 mintues after taking a shower. If your skin still appears flaky and excessively dry, additional applications of moisturizer or lotion during the day is advised.
  2. Soak in normal saline for 10-15 minutes after your normal shower routine.
  3. Wear normal-saline-damp clothes under the dry clothes to help moisturize the skin and reduce itchiness.

Can atopic dermatitis be permanently cured?
Atopic dermatitis is a chronic skin disease with intermittent flare up and remission. However, 50 % of patients with atopic dermatitis will improve by the age of 10, but 1 in 3 patients will have persistent atopic dermatitis into their adulthood. 50% may develop asthma in the future, particularly those with severe atopic dermatitis. 65% will develop allergic rhinitis or hay fever when they grow up.






Article by
Dr Preeda Sangacharoenkit
Pediatric Allergy & Immunology
Doctor profile