Loreto Carrasco: atopic Dermatitis

Atopic dermatitis (ad) is an inflammatory disease of the skin mainly in children it is characterized by itching and a chronic course and recurrent. It is often associated with a family history and/or staff of food allergies, asthma and/or allergic rhinoconjunctivitis, as well as with elevated levels of IgE.

The DA usually appears between the 3rd and the 6th month of life, so that 60% of the cases they made their debut 1 year of age, and about 85% are diagnosed before five years of life. The prevalence of atopic dermatitis (ad) in the general population is difficult to pinpoint, but it is estimated that in developed countries around 20% of children suffer from the disease. Although the majority of children are cured throughout childhood, between 10 and 30% of patients will continue suffering during adult life.

The itching is the most significant sign of the GIVING, being present in practically all patients. Sometimes it is so severe that it causes a lot of irritability in the child, and a vigorous scratching which worsens even more the precarious state of the skin barrier. Usually worse at night and makes sleeping difficult, interfering in the family dynamics and deteriorating the quality of life of the child and their parents or caregivers.

From the morphological point of view we can distinguish acute lesions, subacute and chronic. Acute injuries present with erythema, edema, vesicles and exudation; in the subacute phase, the affected areas become erythematous and scaly, and may exhibit excoriations secondary to scratching. In the phase of chronicity appears lichenification (thickening and hyperpigmentation of the skin induced by scratching continued) and, more rarely, the cracking of the plates liquenificadas. The location of the lesions varies along the evolutionary course of the disease.

The diagnosis of the boxes typical of DA tends to be immediate, but in some occasions it is necessary to make the differential diagnosis with other diseases. Keep in mind that children with atopic dermatitis have an impaired skin barrier which makes them more susceptible to other cutaneous diseases simultaneously, so that the DA can co-exist with some of them.

Criteria for referral of the patient with atopic dermatitis

Although the diagnosis of the boxes typical of DA tends to be immediate, in some occasions it may be necessary the collaboration of the dermatologist. Although there is a general protocol of referral for those patients that require specialized care, a referral of appropriate could be the following:

  1. Diagnostic confirmation.
  2. specific tests (ex: possible allergic contact dermatitis associated)
  3. Valuation of other dermatological processes associated that require body.
  4. Severe forms that affect a major part of the surface
  5. Lawless ways to the treatment (patients who after 1 month of appropriate treatment do not exhibit clinical improvement).
  6. Patients with skin infections from recurring.

A good management of atopic dermatitis includes an appropriate education to patients and their families, avoidance of triggers, an exquisite skin-care and the realization of adequate treatment, all of this aimed to modify or possibly slow down the course of atopy.

At present, there are two groups of topical agents essential to the treatment of the DA: corticosteroids and immunomodulators or topical calcineurin inhibitors (TCI).

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