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Most common atopic dermatitis in infants and children

Atopic dermatitis is a chronic, recurring inflammation of the skin, most common in infants and children. Symptoms include redness, dryness, and intense itching. To care for atopic skin, it is recommended to use emollients, avoid irritants and keep the skin hydrated. Breakouts can lead to blisters and scabs, and to relieve itching, topical creams and antihistamines can be used.

Most common atopic dermatitis in infants and children Most common atopic dermatitis in infants and children

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What is atopic dermatitis and why does it occur?

Atopic dermatitis or atopic skin is a skin disease that is characterized by chronic and recurrent inflammation. It is most common in childhood, but it can also affect adolescents and adults. This condition causes the skin to be dry and present increased sensitivity and irritability due to various factors, both internal and external.

The exact cause of atopic dermatitis is not fully understood, but it is believed to have a genetic component and is also related to an altered immune response in the skin. People with this condition are more likely to have a family history of allergies, such as asthma or allergic rhinitis.

External triggers, such as dry weather, exposure to allergens (such as pollen, dust mites, or pet hair), and certain irritants in skin care products, can aggravate atopic dermatitis symptoms. Furthermore, internal factors such as stress, infections, and hormonal changes can also play a role in the development and worsening of this disease.

Typical symptoms of atopic dermatitis include redness, dryness, intense itching , and the appearance of scaly patches on the skin. The most common areas affected are usually the elbow and knee creases, neck, wrists, and ankles.

What are the causes of atopic skin?

Atopic dermatitis is a complex skin condition that results from a combination of genetic, immunological, and environmental factors . When the skin's natural barrier is disrupted, it becomes more permeable to allergens, which triggers an inflammatory reaction by the immune system.

Genetic predisposition is the main factor causing this skin condition, and is often influenced by a family history of atopic dermatitis or other allergies. In addition to genetic factors, there are other factors, both internal and external, that can affect the onset and severity of the disease.

Among the external factors that influence the symptoms of atopic dermatitis, the weather plays an important role. During winter, low temperatures can increase skin irritability, so it is crucial to maintain constant skin care at this time of year. On the other hand, heat can also be harmful, since it increases sweating and can alter the pH of the skin, which favors the appearance of irritation and itching. Likewise, changes in the bacterial flora of the skin due to these conditions can worsen the situation.

Eczema breakouts on the skin

According to the Hospital del Mar Dermatology Service, eczema is a skin disorder that manifests as skin inflammation. This condition is characterized by a combination of redness, raised bumps or lesions, and sometimes the appearance of small blisters or peeling.

Atopic dermatitis is the most common type of eczema, according to information provided by the Science Foundation for Drugs and Health Products. The Spanish Academy of Dermatology and Venereology highlights that up to a quarter of people who experience atopic dermatitis during their childhood develop eczema on their hands to varying degrees throughout their adult life.

How do I know if I have atopic skin?

It is essential that any unusual alteration that appears on our skin be evaluated by a dermatologist. This specialist will analyze the type of skin, detect possible skin conditions and offer appropriate solutions.

It is important to be alert to any change or different appearance in the skin and keep it well cared for with products that nourish it, specially adapted to our skin type.

Atopic skin characteristics

Atopic skin is characterized by showing symptoms such as inflammation, redness, itching, brittleness and sensitivity. These symptoms arise due to a lack of hydration and/or oil in the skin, which makes it drier than usual and prone to irritation.

Why does atopic dermatitis occur in babies?

The skin of babies and children is different from that of adults due to specific characteristics. Their skin barrier is thinner, and they produce less sebum and sweat, making them particularly sensitive to skin problems.

Family history is the main risk factor for developing atopic dermatitis. If one parent has this condition, the risk of a baby developing it is increased by 1.5 times, while if both parents have it, the risk is multiplied by 3 to 5 times.

Other risk factors that can trigger atopy are a malfunction of the immune system, especially immunoglobulins E and G, alterations in the intestinal bacterial microflora, and a diet rich in sugars and polyunsaturated fatty acids.

Likewise, environmental factors also influence the appearance of atopic skin. Living in industrialized urban settings, regions with low exposure to ultraviolet light, or dry climatic conditions may have an impact on the incidence of this skin condition.

Symptoms of atopic skin in babies and children

In general, atopic skin manifests itself with intense and uncontrollable itching and the presence of eczematous lesions that can appear anywhere on the body.

When atopic dermatitis occurs in nursing babies, the skin lesions are usually more acute and may include intense redness, swelling, abrasions, serous oozing, or scabs. These lesions are distributed in areas such as the face, cheeks, and trunk, but do not affect the diaper area.

In childhood, atopic dermatitis tends to become more localized and chronic, with paler redness, dry skin, and thickening due to repetitive scratching. They tend to especially affect the flexor areas, such as the knees and elbows.

These symptoms are defined according to the Hanifin and Rajka criteria, which are used by medical societies and groups, such as the American Academy of Dermatology. To assess the severity of atopic dermatitis, medical professionals often use the SCORAD (Scoring index of Atopic Dermatitis) scale.

Tips for caring for atopic skin in babies and children

Atopic skin care in babies and children must be personalized, and it is recommended that a specialist evaluate each case. It is essential to provide families with sufficient information to alleviate the symptoms of atopy and improve quality of life.

Today, atopic dermatitis can get better on its own and is treatable. The treatment focuses on improving the skin barrier through hydration, relieving itching, reducing inflammation, balancing the skin's bacterial flora, reducing breakouts, and reducing the risk of infections.

Some tips for the care of babies and children with atopic skin are:

  • Use fragrance-free emollients once or twice a day: These products are essential for the prevention and daily treatment of atopic dermatitis. They help retain moisture in the skin, reducing the severity of lesions and breakouts. It is recommended to use emollients that contain structural lipids such as ceramides, urea, lactic acid, among others, and apply them after bathing.

  • Short baths with lukewarm water : Brief baths of no more than 10 minutes with lukewarm water are recommended. These baths provide hydration and cleanse the skin of crusts, scales, and irritants. It is recommended to use soap-free body cleansers without dyes or perfumes, and pat the skin dry with a hypoallergenic cloth towel before applying the emollient.

  • Choose cotton or linen clothing : Avoid synthetic materials and opt for cotton or linen clothing that is light and soft on the skin. It is important to remove clothing tags that may rub against the skin. Wash clothes with mild detergents specially designed for babies or children with atopic skin.

  • Keep environments clean : It is crucial to keep the house free of dust or animal hair. Maintaining a moderate temperature and 50% humidity in the environment can also be beneficial.

  • Consider natural ingredients : Some topical corticosteroid treatments, the most common, must be prescribed by a doctor and require follow-up. There is increasing evidence that certain natural ingredients, such as sea buckthorn, calendula, black cumin, Boswellia, shea and neem oil, may have good results in repairing the skin barrier and relieving symptoms.

  • Restriction of certain foods in the diet : Limiting certain foods should only be done when in vitro tests detect specific intolerances and it should be evaluated if they really influence the evolution of the disease. This measure is a controversial issue and must be supervised by a specialist.

 

What factors can worsen the symptoms of atopic dermatitis?

  • Allergies to pollen, mold, dust mites, or animals
  • Colds and dry air in the winter
  • Colds or the flu
  • Contact with irritating materials and chemicals
  • Contact with rough materials such as wool
  • Dry skin
  • emotional stress
  • Dry skin from taking frequent baths or showers or swimming frequently
  • Getting too cold or too hot, as well as sudden changes in temperature
  • Perfumes or dyes added to skin soaps or lotions

 

What changes can we see in atopic skin when an outbreak occurs?

  • Blisters that ooze and crust over
  • Dry skin all over the body or bumpy areas on the back of the arms and the front of the thighs
  • discharge or bleeding from the ear
  • Raw skin areas from scratching
  • Changes in skin color, such as more or less color than your normal skin tone
  • Redness or inflammation of the skin around the blisters
  • Thick or leathery areas, which can occur after prolonged scratching or irritation
  • In children younger than 2 years, skin lesions begin on the face, scalp, hands, and feet. This is often an itchy rash with blisters that ooze or crust over.
  • In older children and adults, the rash is most often seen on the inside of the knees and elbows. It can also appear on the neck, hands, and feet.
  • In adults, the rash may be limited to the hands, eyelids, or genitals.
  • Rashes can occur anywhere on the body during an intense outbreak.
  • Intense itching is common. It can start even before the rash appears. Atopic dermatitis is often called an "itchy rash" because the itching starts and then the skin rash appears as a result of scratching.

 

What can we do to avoid scratching the rash or skin?

  1. A moisturizer, topical steroid cream, or other medications prescribed by the health care provider may be used to control symptoms and reduce itching.

  2. It is advisable to take antihistamines by mouth to relieve the intense itching.

  3. Keep nails neatly trimmed and consider wearing soft gloves when sleeping if the person tends to scratch at night.

  4. Skin should be kept hydrated by using ointments (such as petroleum wax), creams, or lotions 2 to 3 times a day. It is important to choose skin products that do not contain alcohol, fragrances, dyes, or other chemicals. Using a home humidifier can also help keep the air moist and benefit your skin.

 

What factors can worsen the symptoms of atopic skin?

  • Foods that can cause an allergic reaction in very young children.
  • Irritating materials, such as wool and lanolin.
  • Strong soaps or detergents, as well as chemicals and solvents.
  • Sudden changes in body temperature and stress, as these can cause sweating and worsen irritation.
  • Triggers that cause allergy symptoms.

 

What should we take into account when bathing the child or baby with atopic skin?

  • The time in contact with water should be limited, opting for short baths with cool water instead of long baths with hot water.
  • It is advisable to use mild body washes and cleansers instead of regular soaps.
  • You should not rub or dry the skin too hard or for a long time.
  • Lubricating creams, lotions, or ointments can be applied to the skin while it is still wet after bathing to help lock moisture into the skin and keep it hydrated.

  1. Spanish Academy of Dermatology and Venereology. Guide for patients with atopic dermatitis.
  2. Frazier, W. and N. Bhardwaj. Atopic Dermatitis: Diagnosis and Treatment. Physician. 2020;101(10):590-598.
  3. Foundation of Medicine Sciences and Sanitary Products. Atopic Dermatitis: from the diagnosis to the definition of a care route. Feb 2019.
  4. Kim, J. et al. Pathophysiology of atopic dermatitis: Clinical implications. Allergy Asthma Proc. 2019 Mar; 40(2): 84?92.
  5. Moreno Giménez, JC Atopic dermatitis. Allergol Immunol Clin 2000;15:279-295.
  6. Dermatology Service of the Hospital del Mar. Eczema.
  7. Silverberg, JI et al. Atopic dermatitis in the pediatric population: A cross-sectional, international epidemiologic study. Ann Allergy Asthma Immunol 126 (2021) 417-428.
  8. Torres, T. et al. Update on Atopic Dermatitis. Acta Med Port 2019 Sep;32(9):606?613.
  9. https://medlineplus.gov/spanish/ency/article/000853.htm

 

Photo: Wikipedia: https://es.wikipedia.org/wiki/Dermatitis_at%C3%B3pica


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