Atopic dermatitis (AD) is a chronic inflammatory disease of the skin that can affect all age groups. It causes concern as the relapsing illness is presented by dermatitis or a rash with itching, which can get unbearable at times. The rashes can cover almost the entire body and can severely affect the Quality of Life of the patient.

‘Heterogeneity’ is the word that best describes AD, as some patients get AD which is seasonal or episodic, while others may exhibit a chronic state of the disease. In children, the disorders may persist even when they reach adulthood. Some may get moderate rashes while others may get severe rashes, and thus the treatment also varies with such heterogeneous symptoms.

The symptoms can range from dry skin, itching, severe during night-time, patches on hands, feet, upper chest, ankles, wrists, neck, knees, eyelids, etc. These may range from red to red brownish-grey. Babies may get rashes on the face and scalp. People with AD can also get bumps that may contain fluid. Yet other symptoms include scaly, cracked, thick skin. The skin can also feel raw and sensitive and may appear swollen from scratching. If you have AD, you must know that it is not contagious.

It is not uncommon for people to ignore the first signs of dermatitis. However, suppose you or your child experience any of the above symptoms. In that case, you must consult a dermatologist at the earliest to determine the severity of the disease and chart a course of treatment. The doctor will perform the necessary tests, ask you about your symptoms, and diagnose your condition. If your child has AD, you must visit a doctor if the child gets irritable, has trouble sleeping at night because of eczema, or if the symptoms get worse. Early initiation of treatment helps in managing the symptoms better. If you delay the treatment, then the rashes tend to spread all over the body, causing the Quality of Life to deteriorate, which significantly impacts your daily life and activities. Suppose you are already seeing a dermatologist and are under medication. In that case, you must consider visiting the doctor if you observe any new symptoms or the current ones worsen, or if your symptoms are coming in the way of your daily routine, or if there are any side effects of the medicines prescribed.

The first line of treatment often consists of hydrating and moisturizing creams or other agents and avoiding any irritants. Then, anti-inflammatory therapies such as steroid creams or ointments and other anti-inflammatory / immune system suppressing creams (calcineurin antagonists) are given to manage the exacerbation. But steroid creams or ointments are the backbone of the treatment of AD. Anti-inflammatory drugs such as steroids and other immune system modulating drugs are prescribed in severe cases of AD. It is, however, established that no single treatment is effective for AD, and the management requires a multi-pronged treatment strategy. Those with widely distributed lesions are treated with a combination of oral anti-Staphylococcal antibiotics until the condition becomes localized, upon which steroid creams or ointments are given to manage the rest of the lesions. The main obstacle in the treatment of AD lies in the fact that there is a limited response to the currently available therapies.

Unfortunately, in some cases of severe illness, the medications available today in the country are insufficient or have many harmful side effects. Therefore, it is essential for the government health authorities to ensure that newer therapies like biologics that are available globally can be made available in the country, particularly for people with moderate-severe forms of AD. This will provide the much-wanted relief to the patients suffering from this unbearable skin condition.

A timely diagnosis and proper treatment can save patients a lot of agony and mounting medical expenses for a lifetime. So, get yourself checked if you experience any of the related symptoms.

By Dr Abhishek De, Assistant Professor, CNMC & Assistant Editor, IJD & IJSA