Patients suffering from atopic dermatitis are becoming more numerous. He is 30 years less than 5% of children had atopic dermatitis, is now approaching 20% (estimates from the ISAAC study, Lancet 1998).
Definition
Atopic dermatitis (AD) is a recurrent skin condition (with periods of worsening and improvement) and characterized by lesions in the form of redness, intense itching and dryness.Dermatology is an entity that is beginning to worry that parents “do not go away” despite treatment established by the pediatrician.
Synonyms: atopic eczema, constitutional eczema, dermatitis in infants.
Epidemiology
It is a common disorder that affects the quality of life for 20% of children and 10% of the general population in France.It usually begins before age 1 year, and improves spontaneously in 80% of cases after the age of 2 years.
Clinical Elementary
The acute phase is characterized by chronologically:
- A phase erythematous
- Then the vesicles with a crumbled appearance of the skin
- Oozing and crusting
- Scaling
Soon all these stages are telescoped in time and the DA becomes chronic dry skin, erythemato-squamous, cracks, lichenification of lesions.
Diagnosis
We define major criteria which is the main and constant itching.
Then we search the following criteria:
- Background skin of achieving the folds of the anterior ankle or neck
- History of xerosis (dry skin)
- Personal history of asthma or rhinitis
- Erythema folds or eczema of the cheeks, forehead and outer members in children under 4 years
- Beginning before age 2 years: ichthyosis and / or keratosis pilaris , tendency to skin infections, nipple eczema, cheilitis, conjunctivitis, recurrent fold Denny Morgan, keratoconus, anterior subcapsular cataract, pigmented peri orbital, pityriasis alba (eruptions), irritation of the anterior neck folds, itching to perspiration, intolerance to wool and lipid solvents, white dermographism white line or delayed onset of scratching, aggravated injury under the influence of environmental factors and emotion.
Environmental factors
- The AD affects mainly the rich industrialized countries, the pollution increases probably dermatitis, but also paradoxically good hygiene with the use of detergents that alter the skin barrier.
- In some cases there may be worsening by dietary factors (allergy to egg, peanut or proteins from cow’s milk), factors airborne (dust mites, pollens, animal dander) or factors contact (irritation hard water or contact allergies to perfumes or metals).
Atopic dermatitis in infants
The eruption predominates in the face, cheeks, respecting the centro-facial region. He is a closet edges crumbled based infiltrated, erythematous surface is studded with vesicles and openings leading to an outcome which is serous oozing concrete transparent crust.The itching is constant and intense, causing The eruption presents separate successive crops of remission: the oozing stops and there is desquamation.excoriations. In two cases, the DA heals before 4 years but often persist rebels sites (flexures) and dry skin.
Atopic dermatitis in children and adults
Sometimes the subject was presented with eczema in infancy, but onset may be later. The face is preferentially affected, but the locations are the characteristics flexures: elbows, popliteal fossae.The lesions are lichenified, pigmented, particularly itchy.Against this background of extensive chronic vesicular subacute succeed. Of asthma, rhinitis or allergic conjunctivitis is superimposed on eczema or alternate with him.
Evolution
In general the course is chronic with alternating exacerbations and remissions, the DA yields often around the age of 3 years but there is a possibility of relapse in adulthood.There is little impact on the overall except in severe cases or if treatment is inadequate or poorly led.
Complications
The risk of complications is dominated by secondary infection: colonization by staphylococcus but feared especially that related to the herpes virus (limited or dangerous and rare Kaposi’s sarcoma-Juliusberg to treat with acyclovir emergency). Risk of onset of asthma of a rhinitis or allergic conjunctivitis.
Treatment and care
– The 1st-line treatment is a symptomatic treatment aimed at controlling inflammation and relieve itching for the patient. The skin care should be everyday: toilet with a non-detergent, apply a dermocoticoïde on eczema and stool on the rest of the body.
– If no response to topical therapy or good conduct if consumed too much topical corticosteroids (more than 30 g tube in an infant), a balance to find aggravating factors must be undertaken to develop implement adequate measures (removal of a food allergy if proven or eviction of a contact allergen).