What is Atopic eczema
Atopic eczema or atopic dermatitis is an inflammatory condition of skin characterized by features like erythema, papulation and infiltration of the skin. Oozing and crushing may even be apparent in severe cases.
The word eczema is derived from Greek word eczein meaning 'to boil over'.
The main symptom is pruritis which worsen by scratching the affected area. Atopic eczema is characterized by increase in serum immunoglobulin E(IgE) which may confer a predisposition to the development of allergies. It may even be associated with other allergic condition like allergic asthama or allergic rhinitis.
Epidemiology of atopic eczema
Researches confer tat prevalence of atopic eczema is marked in industrialized Countries. As per allergy statistics published in 1998 by US National institute of health, the prevalence of Atopic eczema was 9% and was rising and became 15% in reports of 2000.
There are several factors linked with the onset of the disease.
Environmental factors being the main factor which include pollen, house dust, mites, pets, dander, tobacco smoke and traffic pollution. The effect of these factor may be amplified by modern living standard with the use of air condition, central heating, double glazing and carpets which increases indoor allergies and irritants.
Apart from environmental factors studies in monozygotic twins reveals contribution of genetic factors as well. Other factors may be associated are cell-mediated dysfunction, autonomic nervous system dysregulation and psychosomatic influences.
Pathology of Atopic Eczema
The skin has its own immune system, which comprises Langerhans' cells, Keratinocytes, Mast cells, Endothelial cells etc. Atopic eczema is exaggerated cutaneous immune response to environmental antigens. Histologically, edema and pruritis in both chronic and acute lesions are associated with epidermal infilteration by activated T cells and macrophages.
IgE also has a role in pathogenesis of atopic eczema. It can bind to receptor of dendritic cells which can be detected in dermis and epidermis of the patient.
Diagnosis of Atopic Eczema
Diagnosis is based on clinical observation. There is not any predictive or diagnostic test or marker of the disease. The first sign is development of red, scaly and oozing plaques on the forehead and face which may spread to the neck, hands and flexural areas. In severe cases it may extend to whole body. The skin becomes dry and there is extreme itchiness and scratching worsen the condition by predisposing to secondary bacterial infection due to breakage in cell lining.
Burden on life due to Atopic eczema
Atopic eczema is such a disturbing disease that it severely impairs the quality of life of patients, families and carers. Sleep disturbance is the most common hazard seen in about 90% of the patient with atopic eczema. Tiredness, lack of concentration and irritability is often noticed which in turn lead to underachievement in learning abilities and even inability to participate in any activity. A social cut off is most often seen and depression on panic attack may even occur at times.
A proper management helps in improving not only the sign and symptoms of disease but also improves the quality of life. For management for atopic eczema kindly refer to Management of Atopic eczema