Atopic dermatitis is a chronic disorder with periods of exacerbation and relapses. There are three stages (dependent on age) : infantile stage (until the age of 2), childhood stage (2-12 years old), and adult stage. Symptoms change with age.
Although the mechanism of inheritance of the disorder has not yet been fully recognized, AD can be mostly observed among children from urban areas who are genetically prone to developing AD.
Atopic eczema can be observed among 15-20% of children and only 1-2% of adults. Usually, atopic eczema appears for the first time at the age of 2; however, it can also manifest later. The symptoms are the strongest between the age of 2 and 4, and they can disappear during the teen years.
Atopic eczema has become more widespread in recent years. There are many theories concerning the phenomenon. Among factors influencing the disorder are: climate change, pollution, dust and hay allergies, diet, infections and other factors of early life. However, there is no one main cause of AD.
Atopic dermatitis is characterized by a multitude of clinical symptoms. The manifestation of atopic eczema strongly varies among individuals. The most affected areas are skin creases and also elbows, wrists, knees, the back and neck. Usually adults have permanent eczema appearing on hands, eyelids, joints or all these areas. At times red blisters or large dry itchy areas appear. In the meantime the skin can look normal. Acute symptoms may include highly itchy clots and blisters on a rash background. Neurotic excoriations and cutaneous conditions may appear simultaneously with excretion of the serum. Often 2-3 month old boys develop infantile atopic eczema accompanied by inflammation and clot and lymph conditions. Pruritus is one of the few symptoms of the disorder that occur at every age in AD patients.
Atopic eczema is the main factor influencing contact reaction of the skin. Most often it occurs on hands which are exposed to water, detergents and solvents. Adults prone to dry hands who have developed AD in extreme cases may have blisters. Many AD patients experience relapses with no apparent reason. Some exacerbations, however, may be caused by irritants.
Some foodstuffs may cause relapses in sensitized children. The main products that increase the symptoms of the disorder are cow milk, eggs and peanuts. People who are food sensitive should regularly consult an allergist.
In many AD patients, laboratory examinations have indicated higher levels of eosinophil granulocytes in blood and a higher concentration of immunoglobulin E in the serum, but 20% of AD patients showed normal levels of IgE.
Examinations have proven that early childhood is crucial for the development of allergic disorders, namely the first and second year of life. Environmental conditions and exposure to irritants, tobacco smoke in particular, influence not only the degree of seriousness of an allergic disorder but can also accelerate or retard its occurrence.
Atopic dermatitis can be diagnosed on the basis of clinical symptoms. To obtain a correct diagnosis, 3 out of 4 main symptoms have to be recognized according to Jon M. Hanifin and Georg Rajka:
- Characteristic morphology and location of changes
- Chronic and relapsing course
- Individual or family atopic history
Also, at least three minor symptoms are essential: