Atopic dermatitis: Signs & symptoms

Atopic dermatitis (AD), or atopic eczema, is a non-contagious chronic, inflammatory disease of the skin.

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About atopic dermatitis

Triggering factors

Signs & symptoms

Diagnosis

Treatments

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Symptoms and signs

AD is characterized by a non-contagious inflammation of the skin, associated with intense pruritus, which is usually worse at night. AD is one of the most pruriginous (itchy) skin diseases, and pruritus (itchiness) is the first symptom of relapse. In severe cases, patients scratch the areas with AD until bleeding occurs. A common problem in patients with AD is prolonged scratching at night with loss of sleep.

Patients with AD have significant sleep alterations due to the intense pruritus it causes. These alterations include difficulty to get to sleep, frequently waking up at night, and difficulty to wake up in the morning. Insomnia and decrease in total sleep time lead to drowsiness during the day, tiredness, irritability, decrease in concentration, alterations in growth hormone secretion, and behavioral and discipline problems.

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AD symptoms are recurrent. While some patients have a persistently active chronic condition, most have symptoms that increase and decrease, alternating between an active disease and periods of remission.

Patients' skin shows red or brownish patches, dry, cracked or squamous skin (table 1). In infants, eczema generally occurs as small bumps on the cheeks, while older children and adults usually have rashes on knees or elbows (often in the folds of the joints), on the back of hands or on the scalp (table 2).

Table 1. Skin characteristics associated with AD in children and adults.

Table 2. Areas of the body where clinical manifestations of AD may appear by age.

References

  1. Avena-Woods C. Overview of atopic dermatitis. AJMC. 2017;1–10.
  2. Kapur, S., Watson, W., Carr, S. Atopic dermatitis. Allergy Asthma Clin Immunol. 2018;14(s2):1–10.
  3. Nutten, S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66:8–16.
  4. Darsow, U., Raap, U., Ständer, S. Chapter 3 Atopic Dermatitis. NCBI Bookshelf A Serv Natl Libr Med Natl Institutes Heal. 2014;21:1–12.
  5. Wong, ITY., Tsuyuki, R.T., Cresswell-Melville, A., Doiron, P., Drucker, A.M. Guidelines for the management of atopic dermatitis (eczema) for pharmacists. Can Pharm J. 2017;150(5):285–97.

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