Severe and persistent Atopic Dermatitis and flare-ups: All you need to know


Living with atopic dermatitis causes difficulties, and flare-ups often worsen the situation

Atopic dermatitis. Image courtesy User:Assianir

Atopic dermatitis (AD), also known as atopic eczema, is a chronic skin condition that makes the skin dry, itchy, swollen, and red. This condition is common in children and can arise at any age. AD results in long-lasting, gene-linked inflammation, causing skin rashes and itching. These bumps and patches can drain fluid and crack when scratched. Individuals diagnosed with allergic rhinitis, asthma, hay fever, food allergies, and other allergies are more likely to develop this condition.

Although the exact trigger of AD is not explicit, one factor that can be is an overproduction of cells in the immune system that can stimulate inflammation. Patients are more susceptible to skin rashes and itching because of the dry, sensitive condition of their skin, also known as a skin barrier deficiency. An AD patient may have a filaggrin gene mutation. Filaggrin is a vital protein that stimulates skin barrier development and final differentiation of the epidermis. Without enough filaggrin to form a strong skin barrier, it can lead to moisture escape and bacteria and viruses entry. Thus, people living with AD have extremely dry and infection-prone skin.

AD can start at any age and tends to outbreak frequently. Outbreaks initiate impulsive scratch behaviours in the affected area leading to more skin inflammation and causing the symptoms to worsen.

Living with atopic dermatitis causes difficulties, and flare-ups often worsen the situation. Patients experiencing flare-ups may also undergo the following symptoms during the ‘active phase’ or ‘acute phase’:

  • Inflamed reddish brown or grey areas on the body, be it the face, hands, wrists, feet, chest, or bends of the elbows and knees.
  • Severe itching that gets worse at night.
  • Possibly inflamed dry skin that is prone to rubbing.
  • Minor bumps that may crust or ooze fluid.
  • Increasingly stiff and brittle skin.
  • Develops into a secondary skin infection.

The flare-up phase of the disease is one of the most distressing periods as it causes physical pain and affects psychologically. Flare-ups can last for various reasons, but there are specific treatments and lifestyle changes one can adopt to reduce the severity and prolong the period between outbreaks.

It is difficult to identify the exact cause of these flare-ups. The familiar causes are the weather, pollution, sweat, stress, allergies, cigarette smoking, textiles, and jewellery.

How to control flare-ups?

There is presently no known treatment for atopic dermatitis. Nevertheless, self-care methods and dermatologist-prescribed drugs can reduce irritation and stop new flare-ups in milder situations.

AD management and treatment depend on the illness’s extent and scope. It combines skincare, inflammation-reducing medicines, and avoiding triggers. It is mandatory to visit a dermatologist if the flare-ups on the body are frequent or getting worse. For some extreme situations, the presently available treatments are inadequate or have several adverse effects. It becomes paramount for government health officials to ensure that people suffering from moderate-severe forms of AD in India have access to better treatments, such as biologics. People living with moderate-to-severe AD will receive the much-needed relief from this condition.

Self-care that may help:

Use only soft soaps: It is preferable to use mild soap because antibacterial and deodorant soaps tend to dry up our skin and eliminate more natural oils.

Drying off thoroughly: After showering, gently pat skin dry with a soft towel rather than rubbing it vigorously. Immediately after, apply moisturiser on damp skin.

Moisturize your skin at least twice a day: You must moisturise your skin daily in these circumstances, twice in the morning and night. Creams, lotions, and ointments aid in maintaining skin hydration. It may be helpful to use petroleum jelly on your baby’s skin in order to prevent the development of atopic dermatitis.

Take quick showers or baths daily: Baths wash off irritants and keep skin moist. However, taking long baths or using harsh detergents or soaps tends to dry up the skin, so 5 to 10 minutes of shower would be beneficial. Additionally, use lukewarm water rather than hot water.

Early and frequent appointments to the dermatologist- Early treatment during a flare-up will lessen the negative impact atopic dermatitis has on your health and personal and social lives. Besides, dermatologists frequently recommend preventative care to limit the number of flares per year. Thus, for the long-term care of atopic eczema, you must heed your dermatologist’s instructions.

Medication plays an essential role in reducing inflammation, itching, and repairing the skin barrier. Despite the relief that these prescribed medications provide, AD is a lifelong disease that requires constant monitoring or occasional flare-ups. After treating this disease well, rashes can last for several weeks before they disappear or reappear.

The author is Consultant, Hinduja Hospital, Mumbai. Views are personal.

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