Atopic Dermatitis

Atopic dermatitis is a distinctive type of dermatitis which can be easily recognised if the doctor is familiar with the manifestations. There are three main phases of atopic dermatitis depending upon the age of the patient: (I) infantile atopic dermatitis (infantile eczema); (2) childhood atopic dermatitis; and (3) adult atopic dermatitis.

Infantile Atopic Dermatitis

Signs of atopic dermatitis appearing during infancy are called 'infantile atopic dermatitis' or infantile eczema. The earliest manifestations usually appear when the infant is only two-months old and consist of severely itchy eruptions with exudation, which commonly start on both the cheeks and quickly spread to other parts of the face, and then to other regions of the body. Sometimes however, the manifestations can start from some other region of the body rather than the face.

The most characteristic feature of infantile atopic dermatitis is the itching which is far more severe when compared to the intensity of the skin lesions. If the patient is not treated properly it can lead to heavy crusting over the lesions with superadded bacterial infection, and the child can be very uncomfortable. The intensity of the dermatitis can vary from time to time and the pattern also varies in different patients. The disease runs a variable course-it can remit spontaneously in a year or two to reappear at a later stage as c childhood atopic dermatitis, it may not reappear at all throughout the rest of the life of the patient, or it may manifest as asthma or allergic rhinitis at a later stage. In some cases infantile eczema does not remit at all and slowly changes into the childhood phase of atopic dermatitis.

Childhood Atopic Dermatitis

Atopic dermatitis may appear de novo for the first time during childhood without the preceding infantile phase or as continuation of infantile atopic dermatits.

The characteristic severe itching continues but the skin tends to become more and more dry, thickened and pigmented. The exudation from the lesions stops. The lesions tend to get localised to the flexures, the cubital and the popliteal fossae (the space in the fold of the elbow and the knee joints kand the neck. In severe cases, it may affect all parts of the skin in a diffuse or patchy manner. The pattern of exacerbations and remissions varies, depending upon the precipitating factors.

The progression of the disease during this phase also follows the same pattern as infantile eczema-it may remit spontaneously for the rest of the patient's life or it may reappear as adulthood phase of atopic dermatitis. It may change over to another type of atopic disease or it may change into adulthood type of atopic dermatitis.

Adulthood Atopic Dermatitis

Adulthood type of atopic dermatitis may appear for the first time during adult life but it is a relatively rare occurrence. More often it is a continuation of infantile childhood atopic dermatitis. The signs and symptoms are similar to those during the childhood phase but tend to be more severe. The skin gets more thickened, itchy and pigmented.

Some other skin diseases look similar to atopic dermatitis and unfortunately, there is no specific test to diagnose atopic dermatitis. An experienced dermatologist however, can generally distinguish one disease from the other and carry out certain tests to exclude the possibilities of other diseases.