Flare-ups over atopic dermatitis

Treatment and managing atopic dermatitis depends on the severity and extent of the disease. It consists of a combination of trigger avoidance, skincare and medications for inflammation, writes Dr Abhishek De

Atopic dermatitis (AD), also known as atopic eczema, is a chronic relapsing skin condition that makes skin dry, itchy, inflamed and red. This condition is prevalent in children but can occur at any age. It is a long-lasting, gene-linked, inflammatory skin disease that results in widespread rashes and itchy skin. These bumps and patches may ooze liquids and cause cracks when scratched. It has been found to be associated with an individual or due to a family history of allergic rhinitis, asthma, hay fever, food allergies and other allergies.

Although the exact trigger of AD is not well understood, one factor can be an overproduction of cells in the immune system that stimulate inflammation. This, in combination with the dry sensitive nature of the skin, often referred to as skin barrier defect, makes patients prone to skin rashes and itching.

People with AD may have a mutation of a gene called filaggrin which is a key protein that facilitates terminal differentiation of the epidermis and the formation of the skin barrier.

Without enough filaggrin to build a strong skin barrier, moisture can escape and bacteria, viruses and more can enter. Therefore, many people with AD have very dry and infection-prone skin.

AD often starts at an early age and tends to flare up from time to time. During flare-ups, patients with AD tend to scratch the affected area which leads to more skin inflammation, causing the symptoms to worsen.

A flare-up can also be known as the ‘active phase’ or ‘acute phase’ and a patient may also experience the following symptoms during that time:

Inflamed reddish-brown or grey patches on the body, especially on the face, hands, wrist, feet, chest, neck, and elbows and around the bends of the knee.

Severe itching that worsens at night.

Dry skin that could get swollen from scratching.

Small, raised bumps that might crust or leak fluid.

Skin that thickens and cracks. Development of secondary skin infection.

How to prevent a flare-up?

Although one can never determine the triggers for flare-ups, some of the common causes can be climate, pollution, sweat, stress, allergies, smoking cigarettes, fabrics or jewellery. Medications from dermatologists and self-care measures help relieve itching and prevent new outbreaks on the skin in milder cases. It is always recommended to visit a dermatologist if the flare-ups are frequent or are increasing in severity on the body. Treatment and managing AD depends on the severity and extent of the disease. It consists of a combination of trigger avoidance, skincare and medications for inflammation.

Use only gentle soaps: It is better to choose a mild soap as fragrant soaps and antibacterial soaps tend to remove more natural oils and dry our skin.

Dry ourselves carefully: After bathing, gently pat dry the skin with a soft towel and soon after that apply a moisturiser while the skin is still damp.

Moisturise at least twice a day: In such conditions, you need to moisturise your skin daily in the morning and before going to bed. Creams, ointments, and lotions help in locking the moisture inside. Using petroleum jelly on your baby’s skin may help prevent the development of atopic dermatitis.

Take daily short baths or showers: Bathing washes off allergens and keeps your skin moist. However excessive bathing or use of rough soaps or detergents tends to make your skin dry, so limiting your showers to 5-10 minutes would be helpful. Also, the use of lukewarm water, rather than too hot or too cold water, is recommended.

(The author is an Assistant Professor at the Calcutta National Medical College & Hospital.)