Diagnosis and treatments of atopic dermatitis

The diagnosis of atopic dermatitis is clinical and is based on major and minor criteria. Major criteria: itching, fissuring, dryness (scaly skin)

Minor criteria are more complex and can be those:

• Dennie-Morgan sign (infraorbital eyelid fold)
• Pythyriasis alba: this is not a fungus, because when one speaks of Pythyriasis one can have fungus (white, versicolor, on shoulders and neck, recurring at the seaside in summer) or Gilbert’s rose (inflammatory, post-viral, post-infectious skin rash) or precisely the alba. Light hypopigmented patches are present, the expression of dryness and microinflammation of the skin. Rehydrating the person locally with creams reverses the original phenotype.
• hair keratosis: expression of skin dryness, giving hyperkeratosis to the hair follicles. It causes a sandpaper-like appearance on the face and limbs. It is often associated with pythyriasis alba. This keratosis is characterised by itching, often induced by a change in temperature (they scratch as soon as their shirt is taken off), because the temperature is carried by the same fibres as the itching.
• scratching lesions, usually absent in the upper back because one cannot reach them with one’s hands. The interscapularis part is by far the least inflamed, because it is usually not inflamed.

The diagnosis is complex, usually differential. The dermatological examination is fundamental and not obvious, to be concluded even in several sessions if necessary.

Atopic dermatitis can be classified clinically as follows:

• Pure atopic dermatitis: associated only with skin symptoms.
  intrinsic: not appreciable high [IgE].
  extrinsic: appreciable high [IgE], more often symptomatic than intrinsic.
• Mixed atopic dermatitis: gives cutaneous manifestations, but also extracutaneous ones (e.g. respiratory like asthma).
  
  

There are different treatments that can be evaluated by the dermatologist when a case of atopic dermatitis occurs. This will obviously have to be evaluated according to the patient’s needs and the severity of the pathology.

The treatments for atopic dermatitis follow three mainstays. The first is short- and long-term treatment, using corticosteroids and topical calcineurin inhibitors.
Then we have personalised therapy based on the patient’s disorder, as well as new therapeutic approaches that are continually being studied, which must be evaluated on a case-by-case basis.

In the guidelines for the treatment of atopic dermatitis, drawn up by the European Union, the first choice is the administration of cortisone, in quantities that are never exaggerated in order to avoid more serious episodes of the disease.

In children, corticosteroids must be the right kind, designed to be assimilated by their bodies.

In the therapy we then have prophylactic behaviours that must be maintained in order to avoid that the atopic dermatitis expands and becomes even more chronic. We therefore find cleansing techniques, such as avoiding the use of foaming cleansers, but also the use of soaps that respect the physiological pH, which in this case can be defined as below 5.5 on the scale.
It is also very important to avoid all products with strong fragrances, which could make atopic dermatitis worse.

It should be specified that the treatment of atopic dermatitis will not lead to a total resolution of the problem, but it can be alleviated in order to avoid intense itching.

The conclusions of the article

It is very important to point out that if atopic dermatitis is not treated correctly, the complications may not be entirely pleasant. It is therefore essential to visit a dermatologist as soon as possible if you think you have symptoms of atopic dermatitis, so that you can devise a treatment plan that is perfect for your needs.

We can only thank you for having read our article up to this point, and hope that it has been of real use to you in understanding more details about one of the most common skin diseases, both in infants, adolescents and adults, which should be treated and cured as soon as possible in order to avoid unpleasant side effects at all costs!