Atopic dermatitis: what it is and how to treat it

Is there anything more unpleasant than itching on the body? Sometimes you feel like ants are crawling all over your body. Other times, it burns so much that a cold shower is the only solution to avoid scratching with your fingernails. Here are some of the feelings of people diagnosed with atopic dermatitis, an inflammatory skin disease that people with allergies often suffer from.

It is a chronic disorder that usually begins in the first year of life and, although many people recover from it, it can persist into adulthood for others. “In other countries they know it as atypical eczema,” adds Irene Araya, dermatologist at Clínica Santa María. One of the most affected groups are children.

“ According to the texts, up to 20% of them could have atopic dermatitis, while North American studies say that up to 30% of children in this country have it,” he says. “There are also forms that are seen in adolescents and adults that are much more difficult to detect, because an older person is not thought to be able to start out with atopic dermatitis.”

Atopic dermatitis is a disease “in which the skin lacks an effective lipid layer that isolates it from external agents”, explains Andrés Figueroa, dermatologist at Clínica Universidad de los Andes. Therefore, those who suffer from it are more exposed to factors that do not irritate others.

In general, “the skin reddens and itches a lot,” says Clínica Ciudad del Mar dermatologist Salvador Villablanca. “It’s usually long-lasting, which is why it’s chronic, and there are periods when it comes on and goes off.”

Araya also mentions that atopic dermatitis is a genetic and hereditary disease. “Genes associated with the expression of this disease have been detected. A protein, filaggrin, whose mission is to form and maintain the skin barrier, does not work well in them,” he explains.

In normal skin, the lipid layer insulates the immune system from external agents. That is to say, it protects and prevents irritants such as the sun, chemicals or the friction of certain tissues from activating the response of our defense mechanisms.

But when there is atopic dermatitis, “this barrier, the lipid layer, is deficient, so the innate immune system of the skin comes into contact with stimuli from external agents and is activated”, explains Figueroa. “This is how the classic symptoms develop, such as pruritus (itching) and eczema (irritation) of the skin,” he says.

While in babies it is common for red skin to appear all over the body, in adolescents these “plaques” are somewhat more localized, mainly in the antecubital region, which is in front of the elbows, also behind the knees and behind the ears”. This is where outbreaks and lesions mainly occur. In adults, it is more or less similar: redness, flaking and itching.

It is usual for a doctor, if he sees signs of atopic dermatitis in a girl or boy, to ask him if he also has recurrent bronchitis or allergic rhinitis. “It’s a triad,” says Araya. “A lot of times, the allergic compromise is the skin, the nasal mucosa and the bronchi: these are the three areas where this gene could be involved”, he assures.

Once it is detected, “the most important thing is to stop the inflammation, because it is what causes all the symptoms and the evolution of the disease”, specifies the specialist.

The reasons that trigger auto-inflammation in atopic dermatitis are varied, but there are others that are more common. Villablanca refers to “fragrances, the epithelium (skin tissue) of animals, especially cats, certain bacteria that live on the surface of the skin, and dryness, which is very strong and requires constant hydration”.

In the latter case, if there is not adequate hydration, “dry skin begins to itch and scratching generates an immunological inflammatory cascade in the skin. It snowballs, making me itch then scratch, but if I scratch it itches more, and so on.

In the case of children, the person who usually detects the problem is the pediatrician. “Most are patients whose cases can be managed with good hydration and lubrication of the skin. There are some techniques that pediatric dermatologists use: use of moisturizers, antihistamines and itch control, which cause itching and affect sleep quality, generate nervousness and other problems that occur pass on to the family,” he explains.

Atopic dermatitis has no direct link with food. “It is very important to clarify this, because people think that certain foods generate it and it has nothing to do with it,” says Villablanca. However, a food allergy is not exclusive of dermatitis.

“Both conditions are common in one-year-olds. Although atopic dermatitis has nothing to do with food, this does not exclude the possibility of having a food allergy,” he explains.

“It has been described that artificial colorings, particularly in children, can trigger flare-ups of atopic dermatitis, as well as foods high in saturated fat – such as chocolates or ultra-processed ice cream – could increase the severity of flare-ups by because of their pro-inflammatory effect. explains the dermatologist from Clínica de los Andes.

As the three specialists explain, the doctor who administers the treatment gives precise instructions to each patient. Sometimes this includes the use of a corticosteroid cream, but it should not be used freely.

Araya points out that in children, cold saline compresses can be helpful, which somehow reduces inflammation in the skin. “They’ve been used since ancient times and they can really help with a crisis,” he shares.

If you haven’t seen a doctor yet, “you have to use a very slow product, like Vaseline, which can help with relief until the specialist sees it,” adds Villablanca.

The most difficult thing about this disease is that after a certain age it becomes a chronic disease. “Prevention is the most important thing of all, because when there is an attack of atopic dermatitis, we resort to corticosteroids, in cream or in pill, but these are not drugs that we can use very often” , he said.

For this reason, the best way to anticipate is to moisturize the skin every day and “use special and neutral soaps, as well as mild detergents”. Other recommendations are to avoid scented products, which tend to cause irritation.

“This will require special care, both general – such as short showers, cotton clothes, special detergents, a diet not devoid of many dyes – as well as daily lubrication, with a particular cleanser and moisturizers” , adds Figueroa.

Currently, says Araya, the industry has developed quite effective drugs for severe atypical cases, “which are the group that suffers the most.” Unfortunately, these are expensive treatments that are not accessible to everyone. “There are also more accessible therapies, but if for some reason these don’t work, switching to the latest generations will be a difficult and expensive matter,” explains the dermatologist. “It’s something the health authority should address because all of these people are scratching themselves to death, they’re not sleeping well and their quality of life can be terrible if left untreated.”