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Atopic dermatitis is a common skin condition that is encountered frequently in general practice. Here is how to recognise and treat atopic dermatitis in your patients in primary care.

What is atopic dermatitis?

Atopic dermatitis, or eczema, is a condition characterised by itch and persistent rash. Patients with atopic dermatitis have a defective skin barrier and increased trans-epidermal water loss. Severe dryness due to rapid water loss of the skin triggers inflammation and breakdown of the skin barrier. This inflammation manifests as redness and itch, which are the key symptoms we find in atopic dermatitis patients.

Who gets atopic dermatitis?

Eczema often runs in families and may be associated with asthma and allergies. Patients with atopic dermatitis present in childhood, sometimes even in infancy. Though many people with childhood eczema improve with age, severe cases may persist through adulthood.

Recognising atopic dermatitis

Atopic dermatitis involves red, dry patches of skin at the flexural surfaces of the body. The most common areas of involvement include the flexural surface of the neck, antecubital fossa, wrists, and behind the knees.

Babies under a year old may often present with a rash distributed on the extensor surface, such as on the cheeks or elbows. Patients with chronic disease may present with thickened dry plaques from persistent scratching resulting in lichenification.

How to treat atopic dermatitis

Treatment of atopic dermatitis can be challenging. Topical steroids are the mainstay of therapy for mild-to-moderate cases. A moderate potency steroid is appropriate on the body and a milder potency for the face and folds. Chronic use of topical steroids can produce permanent, unwanted side effects such as atrophy and pigment changes in the skin. Use around the eyes may also cause glaucoma and cataracts. These side effects are avoided by proper use, which includes avoiding the eye area, taking breaks and tapering when improved, and using calcineurin inhibitors topically as maintenance therapy.

Patients who do not improve with a topical steroid regimen should seek consultation with a dermatologist.

Tips to help your patient succeed

Atopic dermatitis patients have fundamentally drier skin, which fuels inflammation and skin breakdown. For this reason, moisturising and sensitive skin care are crucial for effective therapy. All patients should be moisturising at least twice a day with either petroleum jelly or a ceramide-containing emollient. All personal care products and detergents should be allergen-free. Simple tips include avoiding anything scented, even if they are “natural” plant-based ingredients.

Counsel your patients to avoid common allergens such as over-the-counter antibiotic ointments, cheap jewellery, and perfumes. These common allergens can often cause persistent eczema even when treated with potent immunosuppressive medications. Children with eczema should also wear cotton underwear and clothes to minimise irritation.

In conclusion

Atopic dermatitis is a common skin condition that is encountered frequently in general practice. This disorder is characterised by dry skin and persistent rash. It often presents in young patients but may persist to adulthood. Topical steroids treat mild-to-moderate cases. Moisturising and avoidance of common allergens are just as crucial as medications for treatment success.  Patients who do not improve with topical steroids should seek further consultation with a dermatologist.

Learn more in the Professional Diploma program in General Dermatology.

References

McAleer MA, O’Regan GM, and Irvine AD. Atopic Dermatitis. In: Dermatology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2012:208-224.

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