“Atopic Dermatitis”: A Discomfort that Affects One’s Quality of Life Advice on Caring for your Skin Coming to You from Chula Dermatologists

The number of atopic dermatitis patients is on the rise.  Chula’s dermatologists advise patients and their families to understand the causes of this incurable disease by focusing on making adjustments, reducing the time spent in air-conditioned environments, and avoiding stress and sunlight while keeping the skin moisturized.

“Itchiness” is something we all are familiar with and have experienced.  However, if itchiness occurs frequently and results in persistent scratching it can be extremely irritating and cause even more damage to the skin while also affecting one’s confidence in living a normal daily life.    “Itchiness” is therefore not a small matter.  If the itch persists with the appearance of rashes these can also be signs of “Atopic Dermatitis” which is now becoming more common in both children and grown-ups.  In some cases, the rash even develops into Pemphigoid boils that destroy one’s confidence and quality of life.  

Associate Professor Dr. Nopadon Noppakun, M.D. a special lecturer in the Dermatology Division, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, 2022 Outstanding Dermatologist for Medical Teachers explained the impact of atopic dermatitis saying “those with allergy rashes are more likely to have bacterial infections from their scratching.  Patients with intense symptoms will find it hard to fall asleep due to the intense itching.  The disease affects their quality of life, causing stress and tension whereby the patient loses self-confidence and tries to avoid social contact.”

Atopic Dermatitis and its symptoms

The key criteria for diagnosing atopic dermatitis is chronic itchiness.  Red rashes can appear in particular areas especially in a child’s first year, like the arms, legs, and cheeks.  After the first year, then a particular rash generally appears in the foldable joints of the arms, legs, and neck.  The patients will also experience dryness in the skin, especially around the eyes, fingerprints become more prominent and rashes appear in the area of the ears, and nipples, the skin on the shin dries up with an appearance much like fish scales.  Patients also experience respiratory symptoms such as asthma, and nasal allergies and become allergic to the weather, for example. 

What causes Atopic Dermatitis?

Atopic Dermatitis is caused by two main factors – the hereditary factor that results in abnormal cell multiplication causing damage to the water barrier which prevents water from evaporating from the body.  The skin dries up easily, therefore, making it easy for foreign substances to penetrate the skin causing inflammation and irritation.  

Another factor is that the body’s immunity works extra hard making it highly sensitive to external foreign substances, for example, the chemicals that we might come into contact with in our daily lives like detergent, soap, perfume, or cosmetics.  Once that happens, allergic reactions occur with skin irritations, itches, and rashes.  Avoidance of such contact will make the symptoms subside and eventually disappear.   

Moreover, environmental and behavioral factors also play a part in stimulating skin allergy rashes for example bathing in warm water or spending time in airconditioned rooms for extended periods making the skin dry, while stress is another factor that affects the body’s immunity.    

Diagnosis of atopic dermatitis relies on the clinical method by observing how the rash spreads, mostly with rashes that have been around for more than six months and are accompanied by itching. Patients are sometimes asked to take blood tests to determine their increased levels of immunity. 

Skin Tests are beneficial for those with respiratory allergies to determine allergies related to dust mites or various types of insects.  Those who suspect allergies are caused by external environments may test themselves by placing the suspicious substance on their backs for 8-10 hours to see whether rashes or itching develop.   In the case of food allergies, questions are asked to find out which types of food cause allergic reactions after which the patient is told to refrain from that certain food and later asked to eat the food again to see if the allergy resumes.  

Treatment of atopic dermatitis

Ointments that contain steroids are the main type of medication to treat atopic dermatitis.  The appropriate dosage must be chosen and administered as needed since overuse can cause side effects.    

“If medication in this group is overused and applied on sensitive parts of the body, such as the face, folds like armpits, and legs, or if the medication is applied to wide areas, it can be absorbed into the body and will suppress the functioning of the suprarenal glands in the same way as ingesting the medication.  Topical effects can include thin skin, brittle veins, fungal infections, or acne.  If the medication is applied around the eyes, it can cause the eye blood pressure to shoot up.  Caution should therefore be exercised and the application of the medication should be under a physician’s supervision.”  Associate Professor Dr. Noppadon cautioned us. 

Today, even though there are non-steroid allergy and itch medications, the cost is still rather high and is therefore prescribed for use in specific areas.  Oral Anti-allergy pills have not been clinically proven to treat the symptoms.  One effective medication is itch-relief medicine which has sedative effects and can cause drowsiness.  Those with acute symptoms may need to rely on immunosuppressants.

“This is an incurable disease, but if patients and their family members understand its origins and make the necessary adjustments, avoiding such things that cause allergies such as woolen clothing, stuffed toys, carpets, or pets, the patients will be able to enjoy a good quality of life and even reduce the amount of medicine they are taking” the doctor concluded.

Basic skin health care for disease prevention

The best way to prevent skin disease is to keep the skin moisturized. Associate Professor Dr. Noppadon left us with the following easy steps to follow:  

• Maintain a balanced diet with the 5 main food groups and make sure to drink enough water 
• Avoid spending too much time in air-conditioning since that can dry out the skin
• When bathing, try to avoid warm water and over-soaping your body.  The soap you use should have skin-coating ingredients to protect the skin from dryness.  Within three minutes after your bath, apply body lotion to retain moisture in the skin.   
• Sunlight destroys the skin.  Avoid being in the sun from 10 a.m. to 3 p.m. and make sure to use adequate sunscreen to protect the skin from signs of advanced aging and coarse textures as well as other blemishes. 

The Dermatology Clinic, King Chulalongkorn Memorial Hospital is located on the 14^th floor of Bhor Por Ror Building both during and outside government office hours.   Services are provided by a team of doctors to treat those with all types of skin problems.  Contact the Division of Dermatology, King Chulalongkorn Memorial Hospital, at telephone numbers 0-2256-5428, 0-2256-5434.

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