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Eczema, atopic dermatitis

Tuesday, 23 December 2014 00:00

Atopic dermatitis, often called eczema, is a form of internal allergy that is expressed in the skin and is characterized by itchiness. Frequently, patients suffering from this condition have a personal or family history of rhinitis, conjuctivitis or asthma. It is associated with a rise in the marker IgE on a blood test, while the extent of elevation is a prognostic marker.

Atopic dermatitis encompasses a spectrum from dry skin to extensive redness with blisters, scalling and intense pruritus. More commonly it affects the insides of elbows and knees. This inflammed skin that appears as if it is 'boiling' lead to the greek descriptive term of 'eczema'.

It is the most common dermatological problem that we see in children from infancy to prepubesence. It usually improves around puberty, although in some cases it continues into adult life. Adult atopic dermatitis can be one of the most persistant problems requiring long term therapy.

Besides from the presence of inflammation, a common characteristic of these patients is a deficit in the epidermal barrier. This barrier is composed of proteins and lipids and this is the reason that hard-strong alkaline soaps worsen the condition.

This is also one of the reasons that use of steroid creams should be temporary and restricted, since extensive use of these preparations weakens even further this barrier leading to more frequent relapses and a rebound effect when they are stopped. Moreover, the inflammed skin is colonized by pathogenic microbes and one must remember that topical steroids decrease the organism's defence where they are applied.

It is therefore essential to give a conclusive therapy with possible dietary and habitual changes, so as to minimize relapses and make them less intense when they do occur. We always take into account the age of the patient, skin sensitivity and compliance. For this reason our therapeutic regimes are not restricted to a simple 'cream' but also don't burden the organism in the short or long run.

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