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Recent allergies, AD, asthma or hay fever

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Recent research states that atopic dermatitis (AD) is a
disease of the immune system. IL-4 and IL-13 cytokines involved in Th2 pathway
and IL-22 cytokine in the Th22 pathway. These cytokines cause skin barrier
defects and inflammation which results in the clinical features of AD.(4)
Therefore, a phenotype of this disease is associated with activation of Th2 and
Th22 T-cells. Mutations in the gene encoding protein filaggrin play role in
exposure to allergens and microbial pathogens and induce Th2 polarization; Th22
cells play roles in skin barrier impairment through IL-22.(3) Atopic dermatitis
associated with an imbalance of TH cells, with a lot more Th2 cells and cytokines
associated with them. In addition, there are also increased levels of IgE
antibodies and eosinophils.(1)

2.How common is this disease? Are there any particular
susceptibility groups?

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Even though it’s the most common form of eczema, it’s also
the most severe and long-lasting. Children often get atopic dermatitis during
first six months of their life and according to the American Academy of
Dermatology, females are more likely than males to get an AD. Even though food
doesn’t cause AD, food allergies to dairy products, shellfish and nuts may
worsen eczema.  Recent studies have shown
that infants, who get AD usually have family members who have allergies, AD,
asthma or hay fever which means that there is a genetic predisposition to AD.
In addition, living in cold climate and in developed country; mother’s age at
the time of the childbirth and in addition may play role in development of
AD.(2) Atopic dermatitis in infants may improve over the time and might even
disappear as a child grows older, but in some cases, they will continue to
experience symptoms of AD trough adulthood.

3.What are the disease symptoms? Signs and symptoms of
atopic dermatitis are varying in different age groups. For instance, Infants
can get an AD as early as 2 or 3 months old. 
A rash can appear suddenly on the scalp, forehead and very often cheeks
making skin dry, scaly, and itchy which may come and go. Infants may have
trouble sleeping because they rub and scratch skin which can lead to skin
infection (5).

If AD begins between 2 years of age and puberty, rash starts
in the elbows creases or knees and later appears on the neck, wrists, ankles
and even in the crease between the legs and buttocks which lead to scaly itchy
patches. Over the time, the skin gets bumpy and thickens.

For adults, symptoms of AD vary from person to person. AD
can appear on different parts of the body: face, eyelids, neck, upper chest as
well as in the creases of the elbows, knees, feet and wrists. Skin appears very
dry, sometimes cracked and much scalier than children. People why had atopic
dermatitis for many years may have itchy thick patches of skin usually darker
than the rest of the skin.(2)

4.What mechanisms are responsible for these disease
symptoms?

 Impaired skin barrier
function play role in the development of atopic dermatitis. Deficiency of
filaggrin- proteins that bind to keratin fibers in the epidermal cells results
in a reduction in natural moisturizing factors, flattening of surface skin
cells, disruption of the organization of the lamellar bilayers and rising of
skin pH which stimulates serine protease activity that produces cytokines
IL-1alpha and IL-1beta and stimulate skin inflammation. Cytokines associated
with Th2 contribute to increased permeability and water loss through the skin, abilities
for irritants and allergens to penetrate the skin, reduced fatty acid, and a
low number of antimicrobial peptides can lead to colonization of bacteria in
affected area which make it harder to control.(4) Keratinocytes produce thymic
stromal lymphopoietin that activates myeloid dendritic cells can affect Th
cells balance further. Eosinophils and mast cells involved in the inflammation
via Th2 cytokines. Many studies showed increased numbers of mast cells in skin
lesions associated with an AD.   Release
of pruritogenic substances by mast cells cause scratching that further damage
the skin barrier.(3)  

5.How is the diagnosis made? What particular clinical tests
are used to make this diagnosis?   

To identify atopic dermatitis lab tests are not necessary. A
doctor can diagnosis based on examination of the skin and reviewing medical
history and asking questions about potential food allergies and triggers that
might worsen the condition such as pollen, dust, sweat, soaps, detergents and
stress. In addition, they may ask a patient to do a patch testing which
involves placing very small amounts of allergens on the skin and checking skin
for reactions after a few hours, then after 24 and 72 hours.(1)

6.What is the prognosis for someone with this disease?

Atopic dermatitis can be persistent. People often try
different treatments for many months or years to control it. Unfortunately,
even with successful treatment, signs and symptoms may return. Studies have
found that when AD develops in an infant or young child, the child tends to get
better with time. For some children, the condition completely disappears by age
2; however, about 50% of the children who get AD will have it as an adult.
Since there are so many complications AD patients may experience such as hay
fever, asthma, skin infections and contact dermatitis, it is very important to
diagnose a condition and start treatment.(1)

7.What are the treatment options?

Treatment can’t cure AD, but it can keep it under control.
To control itching hydrocortisone can be applied to affected area and
antihistamines such as Zyrtec or Allegra can be used. In addition, inhibitors
of calcineurin such as Elidel and Protopic can be prescribed. To treat skin
infections, antibiotic cream or oral antibiotics prescribed. To control
inflammation oral corticosteroids such as prednisone can be used.  For people with severe atopic dermatitis who
do not respond well to other treatments, FDA has recently approved a new
injectable monoclonal antibody called Dupixent. Studies have shown that it is
effective and safe but very expensive. For people with widespread lesions
wrapping the affected area with topical corticosteroids and wet bandages is
another treatment option. (2) In cases, when topical treatments don’t work or
if patients very fast flare again after treatment light therapy which involves
exposing the skin to narrow band ultraviolet B and ultraviolet A may be used.
Some people become embarrassed and even frustrated by their skin condition
which may lead to anxiety and depression. In this case, seeing a psychologist
might be very helpful.(1)

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