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Skin Dryness

Atopic dermatitis is a chronic skin disease characterized by itchy, recurrent attacks of eczema on the skin. Although the disease is mostly seen in children, it can occur in any period of life.

In individuals with atopic dermatitis, it is common to see other diseases with atopy, such as asthma, allergic rhinitis and allergic conjunctivitis. Genetic, immunological and environmental factors play a role in the etiopathogenesis of the disease.

There are some structural deficiencies that should be present in the skin in individuals with genetically atopic dermatitis. The water retention of the stratum corneum layer in the upper layer of the skin, defined as skin lipids and epidermis, has decreased.

A large proportion of individuals with atopic dermatitis have a reaction to aeroallergens such as house dust mites and meadow pollen. Specific food allergens are especially important in childhood. It is not clear whether the bacterium Staphylococcus aerius is the trigger of the disease or whether it accompanies the disease lesions.

The skin is itchy and dry in almost all patients with atopic dermatitis. Specific to the age period in which it is seen (i; in infancy: the outer surfaces of the face, arms and legs, ii; in the childhood-adulthood period: the inner surfaces of the knees and elbows), redness of the skin, coarsening of the skin due to scratching, and sometimes wound formation are observed. In severe cases, eczema attacks can be seen all over the body.

60% of the disease begins in childhood. Atopic dermatitis lesions in infancy typically appear after 3 months.

Diagnosis

The diagnosis of the disease was first described by Hanifin Rajka criteria in 1980. Today, however, the 2003 modified Hanifin criteria are used.

Mandatory Features

Pruritus
Eczema (Acute, subacute and chronic)
Typical morphology and age-related specific involvement
Chronic and recurrent history
Key Features: Findings seen in most cases and supporting the diagnosis
History of early-onset disease
Atopy
Personal and/or family history of atopy
IgE reactivity
Xerosis

Associated Features

Required but non-specific features to support the diagnosis
Atypical vascular response
Keratosis pilaris/ pityriasis alba/ palmar hyperlinearity/ ichthyosis/ ocular-periorbital change
Other findings: perioral, periaricular lesions
Perifollicular prominence, lichenification, prurigo lesions

The following diseases should be excluded for diagnosis:
  • Scabies
  • Seborrheic Dermatitis
  • Contact dermatitis
  • Ichthyosis
  • Cutaneous T Cell Lymphoma
  • Psoriasis
  • Photosensitive Dermatoses
  • Immunodeficiency Diseases
  • Other causes of erythroderma

Treatment


Patient compliance is important because atopic dermatitis is a chronic and recurrent disease.

  • In the first step of the treatment, it is important to stay away from woolen and synthetic clothes that will cause a reaction on the skin, soaps and shampoos with a pronounced drying effect, allergic foods determined in infancy, and foods with additives in childhood and adulthood.
  • Soap, hair and body shampoos that are suitable for skin pH, low in additives and high in moisturizing the skin should be used. The skin should be moistened every night as a routine, twice a day during the attack period.

** The drug should be used first, and after the drug application, a moisturizer should be used.

Topical and systemic steroid use:
Topically applied corticosteroids are the first line of treatment. However, the type and duration of the cortisone cream to be used varies according to the age of the patient, the area of application and the severity of the lesion. Most parents and individuals with atopic dermatitis refuse to use steroids because they have a phobia of steroids. The important thing in the use of topical steroids is to follow your dermatologist's recommendations.

  • Systemic steroids can be used in the acute period when they are severe.
  • Topical calcineurin inhibitors: (Tacrolimus, Pimecrolimus)
  • It may cause partial burning and stinging with topical application. They can be used alone or in alternation with topical steroids.
  • Oral Antihistamines: Sedative antihistamines can be used to relieve itching.
  • Cyclosporine, omalizumab, and phototherapy can be used in resistant cases.

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