Dermatology and aesthetics
DermatitisAtopic dermatitis Contact dermatitis Seborrheic dermatitis
- Atopic dermatitis
- Contact dermatitis
- Seborrheic dermatitis
Atopic dermatitis is an inflammatory disease with a fluctuating chronic course, in which, in other words, periods of improvement and phases of deterioration alternate. Its clinical signs consist of inflammation and dryness of the skin (xerosis), in most cases accompanied by itching (which, on the contrary, is often the first manifestation of this disease) also particularly intense; the pathology can be framed within the syndrome of the atopic subject (or atopy), which is characterized by allergic manifestations; the association with bronchial asthma and allergic rhinitis is frequent (50%), cases in which atopic dermatitis usually precedes respiratory symptoms, while less usual is that with eye diseases such as atopic conjunctivitis and atopic cataract.
Atopic dermatitis is a frequent pathology and affects 10-20% of the pediatric population; the first manifestations usually arise in young children (before the year of life), while its evolution is varied. The symptoms usually regress before the start of school age, but in some cases (1-3%) it can go on into adulthood. The disease has a strong genetic component, with an autosomal polygenic mode of transmission; in fact, a child has a probability of presenting the pathology of about 20-25% if a parent is affected, 50% if both parents are affected.
Several factors can trigger the development of the disease through immunological mechanisms. In particular, environmental factors include inhalation allergens (for example dust mites), food allergens, from animals and bacterial antigens. An alteration of the skin barrier can represent an aggravating factor of the disease, but it can also be an important cause in the initial triggering or in the exacerbation of the skin manifestations. Patients with atopic dermatitis have a dry skin that makes it rough to the touch, thin and more prone to flaking and fissuring: all situations that damage it or alter its state (for example contact with irritants, sudden changes temperature and chafing) can trigger or exacerbate skin manifestations. Atopic dermatitis occurs with numerous clinical pictures, which can vary widely depending on the age of the patient: in particular, atopic dermatitis of the infant, one of childhood and one of the adult, are recognized. Classically, to make a diagnosis, there must be three major criteria, or a major criterion associated with at least three minor criteria. Atopic dermatitis of the infant begins in the first months of life, usually in the second-third month, and affects the whole body, but in particular the cheeks, chin (the central-facial area is spared) and the scalp; subsequently the extensor surfaces of the extremities may also be involved (the diaper area is spared). On the skin first red spots appear, then small blisters; these can break, causing liquid to escape, which can settle and give rise to sometimes even important crusty formations. The child is often restless and also has intense itching. There may be bacterial superinfection caused by staphylococcus aureus. Unlike that of the infant, adult atopic dermatitis affects the perioral region (around the mouth), the eyelids, the back of the hands, the retroauricular and nuchal site, sometimes the lower limbs. The skin is dry, rough to the touch, thickened; in certain areas, such as large folds and face (around the mouth and eyes and at the lip commissure), there may be lichenification.
An almost always present symptom is the itching, sometimes sudden onset, which in some cases can be particularly intense.
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