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Dr Schröder: Atopic dermatitis 101

Atopic eczema is a chronic skin disease which is very common especially in the Northern countries. Dermatology specialist and MD Marika Schröder talks us through the root causes, how to treat atopic skin and what to consider in skincare. Read more!

What is atopic dermatitis?

Atopic dermatitis, also known as atopic eczema, is an itching and chronic skin disease, that is very common in the Northern countries. It is characterised by dry, itchy and inflamed skin on areas such as the face (eyelids are often involved), neck, trunk and extremities (especially at the flexure areas). It is really common in kids but can occur at any age. One fourth of the patients have symptoms long into adulthood or even through their whole life.

How is atopic dermatitis diagnosed?

The diagnosis is clinical. There is usually no need for allergy tests, since atopic dermatitis is rarely caused solely by food or other external allergies. Laboratory tests or skin biopsies can be taken in some cases, but usually they are not needed for the diagnosis.

What are the root causes of atopic dermatitis?

If the atopic dermatitis starts before the age of 1, food allergies might be excluded by a dermatologist or pediatric physician who is specialised in the matter. Food allergies in small children is a field of medicine that has been studied a lot during recent years and therefore it is important that the physician is up-to-date with recommendations, guidelines and treatments. Adults can avoid those food agents which they associate with flare-ups of their atopic dermatitis, but e.g. milk or wheat or other major food agents usually do not have any effect on adult atopic skin and therefore allergy tests are unnecessary. Even though adults might have positive results in allergy tests, the connection with skin symptoms should be concluded only if the symptoms can be proven by avoidance and exposure of the suspected food agent. Also children with food allergies usually grow out of the tendency in time, tolerance is gradually built under the strict guidance of a doctor. Some food allergies might be permanent and really dangerous for the patient (eg. nut allergies) but these foods usually don't have any effect on the eczema since strict avoidance still does not prevent the skin symptoms.

The tendency to get atopic dermatitis is genetic  - if both parents have atopic eczema the risk of the disease in their children is about 70%. Atopic dermatitis is often associated with other atopic symptoms such as allergies against pollen or animals, even though both might exist without the other. Pollen and animals might cause flare-ups of atopic eczema in some people, but the avoidance of these agents does usually not cure the symptoms entirely, in the same manner as mentioned above concerning food allergies. Astma can also be associated with atopic conditions.

Stress and other mental causes might have a big impact on flare-ups of atopic dermatitis. Also humidity of the air and sun exposure might have a positive effect for some people. All in all – atopic dermatitis is an intrinsic disease and the skin symptoms might occur entirely without any clear external causes.

What are the common treatments for atopic dermatitis?

The treatment of atopic dermatitis is symptomatic, and it is important that the patient understands that the disease is chronic and can not be entirely cured. The treatments aims to calm the symptoms and reduce flare-ups. 

If there is visible eczema, the skin needs a medical topical cream, such as corticosteroids or takrolimus/pimekrolimus. Sometimes UV-treatments or systemic medications are needed. During recent years, new biologic medical treatments have been developed for really severe cases that do not respond to other treatment modalities.

In terms of skincare, it's important to moisturise dry skin properly and avoid soap and other drying agents such as alcohol. For moisturisers, heavier ointments , salves and balms with higher oil content may be more effective than thin lotions. For all types of skincare products, mildly fragranced or fragrance-free may also be a less irritating option.      

Marika Schröder (MD, PhD) is a Finnish specialist in dermatology with years of experience diagnosing and treating skin cancer and skin diseases, working both surgically and with laser. She is interested in aesthetic skin procedures and has in-depth knowledge of new treatment forms for atopic dermatitis. Dr Schröder heads the Skin and Aesthetics Division at Pihlajalinna Hospital, one of Finland’s leading providers of social and healthcare services.

Dr Schröder is available for video and telephone appointments during corona restrictions; atopic dermatitis is treatable at a distance and does not require face to face consultation. You can book online here

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