Symptoms of atopic dermatitis
The symptoms vary slightly according to age. In infancy a so-called milk crust is often conspicuous. The name refers to the appearance of the cradle.
Milk crust is a crusty, white rash on the child’s scalp. Infants may also have weeping skin areas, scaly whitish skin and scratch marks. Older children have scaly, whitish skin, especially on the bends of the arms and the back of the knees as well as on the hands and neck.
The skin is thickened in some areas and appears coarse. Children also complain of itching and dry lips, as well as skin tears on the mouth and earlobes. Bacteria can easily penetrate through the open, cracked skin and cause inflammation.
In adulthood the symptoms hardly change. Here, too, the flexion sides of the arms and legs are particularly affected. The severe itching is often perceived as the main symptom.
It is triggered by the injured, irritated skin. Scratching the skin, however, creates a vicious circle, because the scratching causes new skin irritations, which in turn promotes the itching. The itching is felt to be disturbing, especially at night, and many patients complain about sleep deficits and overtiredness.
This also often represents a psychological strain for the patient, as he or she no longer feels able to perform. Some patients also suffer from social exclusion and reduced self-confidence. Children in particular react to their symptoms with increased stress, which can be a trigger factor again.
Other symptoms are paleness around the mouth, a double eyelid crease, skin inflammation on the nipples and a whitish skin reaction after scratching (demographism). As already mentioned above, scratched skin carries the risk of bacteria penetrating and causing an infection. The cracked skin areas are often colonized by the bacterium Staphylococcus aureus.
These bacteria aggravate the symptoms and intensify the disease process. Fungi also feel comfortable in the affected skin areas and can lead to inflammation. Infection with the herpes virus occurs less frequently.
If the skin is infected with this virus, eczema herpaticum can develop, which can often only be treated in hospital. The treatment of atopic dermatitis depends on age and the degree of the disease. There are many treatment approaches, not every treatment is suitable for all patients.
Often different treatments must be combined, discontinued and recombined. It may take some time before the right treatment is found. The therapy has different stages, from basic therapy as stage one to therapy with cyclosporines which is stage four.
- Stage 1: The basic therapy includes the treatment of the skin with various creams, ointments and lotions. Depending on the severity of the disease, the composition of the preparations changes. It is often necessary to first try out which cream or lotion will help best.
Skin care is used to help the skin protect itself from the pathogens and to soothe rough areas. If the skin is infected with bacteria, it may be necessary to apply an additional antibacterial ointment. For yeast/fungal infections, antimycotic ointments are available.
- 2nd step: If this therapy is not sufficient, the second step is used. It consists of ointments with glucocorticoids. There are different classes of glucocorticoids, from stage one to three.
Depending on the severity of the condition, it may be necessary to use the highest level, which would be level three of atopic dermatitis therapy. If you are taking glucocorticoids, please note that glucocorticoids should never be discontinued abruptly as this may worsen the symptoms. Glucocorticoids must always be “weaned out”.
Please consult your doctor about this. Apart from glucocorticoids, other substances that influence the immune system can also be used. Other commonly used substances are tacrolism and pimecrolism.
- Stage 4: The fourth stage consists of systemic therapy, which means that the drugs are no longer applied to the skin but taken. For this purpose, there is a choice of different medications. One is antihistamines, which relieve the itching. Cortisone can be taken systemically in severe attacks. There is also the immunosuppressive drug ciclospoprin A, which can be taken in very severe forms of atopic dermatitis.
