Atopic Dermatitis Overview

Atopic Dermatitis

Atopy = a group of diseases where there is often an inherited tendency to develop other allergic conditions,

such as asthma and allergic rhinitis.

Atopic dermatitis (eczema) is a condition that makes your skin red and itchy. It's common in children but can occur at any age.

 Atopic dermatitis is long lasting (chronic) and tends to flare periodically. It may be accompanied by asthma or hay fever

§  Inflammation of the skin

§  Several types of dermatitis

§  Atopic dermatitis (AD) is the most common

§  AD used interchangeably with eczema

Atopic dermatitis most often begins before age 5 and may persist into adolescence and adulthood. For some people,

 it flares periodically and then clears up for a time, even for several years.

Types of Dermatitis
Allergic Contact Dermatitis	Poison ivy
Atopic Dermatitis	Chronic itchy inflamed skin
Contact Dermatitis	Localized reaction i.e. to a chemical
Dyshidrotic Eczema	Blisters that itch and burn on the palms of hands and soles of feet
Neurodermatitis	Patches of skin caused by localized itch i.e. mosquito
Nummular Eczema	Coin-shaped patches in arms, back, buttocks and lower legs – itchy
Seborrhoeic Dermatitis	Yellowish, scaly patches over parts of the body
Stasis Dermatitis	Skin irritation in legs due to circulatory problems

Atopic Dermatitis Causes

•      Dry skin

•      Itching, which may be severe, especially at night

•      Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and in infants, the face and scalp

•      Small, raised bumps, which may leak fluid and crust over when scratched

•      Thickened, cracked, scaly skin

•      Raw, sensitive, swollen skin from scratching

•      Complex multi-factorial condition for which no precise cause has been determined

•      Heightened risk of atopic dermatitis in people with hereditary disposition to allergies

•      The presence of a fragile cutaneous barrier has been demonstrated

•      AD sufferers have a low level of one cytokine that is essential to the immune system and a high level of other cytokines that lead to allergic reactions

•      The immune system can become misguided and create inflammation in the skin

•      Main component of atopic dermatitis = pruritus

Atopic Dermatitis Overview

Infants

•      begins at around 3 months

•      intense pruritus

•      affects face and convex areas of the limbs

•      oozing, crusty lesions

Children

•      skin folds: elbows, knees and neck

•      stronghold areas:  hands, wrists, ankles

•      painful cracks may appear in the skin

•      more frequent flare-ups in autumn-winter

Treatment of Atopic Dermatitis

•      Hydrate the skin

•      Eliminate inflammation and infection

•      Avoid exacerbating factors

•      Moisturize your skin at least twice a day.

•      Try to identify and avoid triggers that worsen the condition. foods, including eggs, milk, soy and wheat.

•      Talk with your child's doctor about identifying potential food allergies.

•      Use only gentle soaps. Choose mild soaps. Deodorant soaps and antibacterial soaps can remove more natural oils and dry your skin.

•      Dry yourself carefully. After bathing gently pat your skin dry with a soft towel and apply moisturizer while your skin is still damp.  

 

How do you treat dry skin

Symptoms

The mejor problem which is occur during the winter session 

•A feeling of skin tightness, especially after showering, bathing or swimming
•Skin appears shrunken or dehydrated
•Skin looks rough rather than smooth
•Itching (pruritus) that sometimes may be intense
•Slight to severe flaking, scaling or peeling
•Fine lines or cracks
•Redness
•Deep fissures that may bleed

Causes

Climatic Conditions
Cold temperatures
 Very low humidity which is typically seen in the winter
Excessive sun exposure
Internal factors : age, overall, health genetics, the family history and personal history
External Factors:
Bathing too frequently with harsh soaps or very hot water
Using cleaning agents/sanitizers containing alcohol
Too much exposure to sunlight & pollutants

Treatment Options

Moisturizers and emollients

•Decrease dryness and scaling, leaving the skin feeling more comfortable.
•Barrier repair moisturizers also known as physiologic moisturizers, contain some of the essential oils that are missing from eczematous skin

Benefits of Sunscreen

Why Should use Sunscreen

1.Prevent from harmful UV radiations.

2.Prevent from premature aging and hyper-pigmentation, melasma .

3.Reduce the risk of skin cancer.

4.Prevent fron sunburn.

How to choose sunscreen

As Per Indian climate SPF 25+ sunscreen is good. But in USA and UK it should be 50+ SPF
Sunscreen has advantage of both physical & chemical barriers so; it provides broad spectrum protection from UV A and UV B solar radiation.

Sunscreen offers protection in a moisturizing non greasy lotion base hence it offers better patient compliance

Sunscreen should be water resistant so; it is an ideal choice for the humid weather conditions of India.

How to Apply Sunscreen 

1. Apply sunscreen before 30 min to go in direct sunlight.

2.Reapply sunscreen after 3 hour , if SPF is more then 30.

3.Use Sunscreen Daily.

Use of Sunscreen  

1.Hyperpigmentation / Melasma

    

2. Sunburn 

    

3.Vitiligo

Causes of Hair fall and Growth Cycle

Causes of hair fall

•  Hormonal changes associated with pregnancy, childbirth.
• An autoimmune disease that attacks hair follicles.
• Scalp  fungal infections .
• Physical stress can cause hair loss .
• Zinc and Iron deficiency are the most common nutritional which lead to hair loss 

Hair Growth Cycle
•The follicular life cycle can be divided into 3 phases:
–Anagen Phase-The phase of active growth
–Catagen Phase
•Marks follicular regression
•Club hair transitions upwards toward skin pore and dermal papilla begins to separate from follicle
–Telogen Phase
•Represents a resting period
•Dermal papilla fully separates from follicle. 

 

84% of scalp hairs are in the anagen phase, 1-2% are in the catagen phase, and 10-15% are in the telogen phase.

Types of Hair Loss

Androgenetic Alopecia

•Slow growth of hair as well as weaker stands of hair
•Cause could be hereditary

 Cicatricial Alopecia

•Also called ‘scarring alopecia’
•Caused by inflammation

Alopecia Areata

•Is an autoimmune disease
•Body's own immune system mistakenly attacks the hair follicles
•hair falls out in small, round patches

Treatment Options

•Lifestyle Modification

•Prescription 1st line drugs

–Minoxidil
–Finasteride

•Hair transplantation

–Involves using small grafts of naturally-occurring units of one to four hairs, called follicular units, to move hair-producing follicles to balding areas of the hair restoration patient's scalp

•Laser therapy

Characteristics of Human Hair

•Stratum corneum of the skin is composed of pliable soft keratin
•Hair and nails are composed of hard keratin
–Toughened by disulfide bridges between molecules
•Hair found almost everywhere on the body
–Differences between sexes or individuals is really difference in texture and color of hair

Structure of Hair and Follicle

•Cross section of hair has 3 parts:
oMedulla
oCortex – Inner side of hair
»The cortex is filled with strands of keratin protein
»Keratin form long stretchy rubber band like strands
»These strands give hair it's strength and help support waves and curls
oCuticle layers
»Closed cuticle keeps the proper balance of moisture and protein inside the cortex
Hair color is due to pigment in cells of cortex

Dark Circle or Periorbital melanosis

Causes of facial melanoses (Dark circles)

• Genetic background and Heredity 

• Physical and emotional stress

• Sun Exposure

• Allergic reaction

• Life style : Excess of Alcohol & cigarettes

• Lack of sleep can also cause fluid to build underneath your eyes 

• In a primary cause the increased pigmentation is found under both eyes and occurs spontaneously

• Dark circles under your eyes may also be triggered from the oxidation of blood leaking from the blood vessels around the eyes

•  Dark circle are caused by multiple etiologic factors that include genetic,postinflammatory hyperpigmentation

Atopic or allergic contact dermatitis,  faulty habits, periorbital edema, superficial location of vasculature, and shadowing due to skin laxity, etc. 

Periorbital melanosis (Dark circles) Diagnosis

T    This is a common worldwide problem.

Complex in pathogenesis, and lacking straightforward therapeutic options. Periorbital melanosis is defined as bilateral, homogeneous hyperchromic macules and patches primarily involving the lower eyelids but also sometimes extending towards the upper eyelids.

A thorough history and clinical assessment of the lower eyelids and cheeks.

Home remedies to remove dark circles

• Put cucumber slices on eye
• Massage aloe vera pulp under the eyes for 10 minutes 

• Mask of mint leaves applying  on the DC affected area.

General Medical Treatment of Dark circles

 

Home Remedies For Dark Circles

1. Sweet Almond Oil For Dark Circles

1.     Apply a little amount of almond oil on your dark circles and gently massage it into the skin.

2.     Leave it on overnight and wash it off the next morning.

Do this every night before going to bed till you see the dark circles disappear.
2. Aloe Vera Gel For Dark Circles

1.     Apply the gel under the eyes and massage for a few seconds.

2.     Leave it on for about 10-12 minutes. Clean with a moist cotton pad.

Do this once during the day and once before going to bed.

3. Argan Oil For Dark Circles

1. Apply the oil under the eyes using the ring finger or the pinky finger.
2. Tap lightly to enhance the absorption of the oil into the skin.
3. Do not rinse it off.
Do this at night, before going to bed.

• Increase your skin's rate of aging
• Increase skin barrier damage
• Leads to loss of skin glow

4. Apple Cider Vinegar For Dark Circles

1. Dip the Q-tip in the ACV and apply under the eyes.
2. Let it dry naturally.
Repeat this twice a day.

Caution

Be careful not to get any vinegar in your eyes. If you do, rinse your eyes with clean water thoroughly.

5. Coconut Oil For Dark Circles

1. Pat the oil on the skin under your eyes.
2. Massage very gently in clockwise and anti-clockwise motions a few times.
3. Leave it on overnight.
Repeat this every night before going to bed.

6. Castor Oil For Dark Circles

Take Organic castor oil
Apply castor oil under the eyes and leave it on overnight.
Do this every night.

7. Cucumber For Dark Circles

Take one fresh cucumber
1. Cut the cucumber into thick slices and place them in the refrigerator for about 30 minutes.
2. Take two slices and place them on the eyes, ensuring they completely cover the affected area.
3. Leave them on for 10 minutes, and then wash your eyes with cold water.
Twice a day for about a week.

8. Tomato For Dark Circles

• 1 teaspoon tomato juice
• 1 teaspoon lemon juice

What You Have To Do

1. Mix the tomato juice with lemon juice and apply this mixture on the affected area.
2. Leave it on for 10 minutes and wash off with cold water.
Repeat twice a day, and follow it for about two to three weeks.

Caution

If you have sensitive skin, add a teaspoon of rose water to the above mix before using it on the under eye area.

9. Green Tea Bags For Dark Circles

Two green tea bags
1. Dip the tea bags in water and refrigerate them for a while.
2. Place the cool tea bags over your eyes for about 15 minutes. Then, wash your face.
Do this daily until there is considerable improvement.

10. Grapeseed Oil For Dark Circles

Take 2-3 drops grapeseed oil
Gently apply the oil on the affected area and leave it on.

• Increase your skin's rate of aging
• Increase skin barrier damage
• Leads to loss of skin glow 

Note: Understand which products suit your skin, and if you have any allergy please do not apply it.