Atopic dermatitis or eczema is a skin disease of allergic origin and like all allergic diseases is characterized by hereditary predisposition. It is a very common disease in children, affecting at least 10% of infants, occurs in both sexes and usually starts after the first month of life. It is characterized by lesions in the upper layer of the skin such as redness, dryness and scaling - the main feature is the presence of intense itching. Depending on age, the areas of the body that are generally affected change: thus, in infants the main location is the cheeks and the scalp where it appears as a severe seborrhoeic dermatitis (pinkeye). In childhood, eczema is mainly located on the flexor surfaces of the limbs (inside the elbow and behind the knees), on the wrists, neck and eyelids, and the lesions are mainly redness, dryness, scaling and pigmentation caused by intense itching. In severe cases, blisters and vesicles are formed which may serrate. If the lesions, due to the intense itching, are contaminated by a microbe, the clinical picture is further aggravated and treatment is more difficult.

Factors that can worsen eczema include:

• Environmental factors such as cold weather (typically atopic dermatitis gets worse in winter and better in summer), allergens (dust, pollens, fungi) and contact with irritants such as those found in soaps and detergents and synthetic or woolen clothing.
• Simple viral infections such as the common cold can lead to an outbreak of atopic dermatitis. So can vaccinations.
• More serious bacterial or viral infections can aggravate the disease. Bacterial infections (mainly staphylococcus) may contaminate the eczematous lesions, giving the skin a picture of intense inflammation with a yellowish tinge and purpuric lesions. In this case, antibiotic treatment is mandatory. A severe viral infection of eczema can be caused by the herpes simplex virus, causing extensive and painful lesions on the skin which can only be treated with specific antiviral treatment.
• Dryness of the skin from inadequate skin care.
• Psychological stress.

Diagnosis is based on the clinical picture and medical history and usually does not require laboratory testing. If necessary, the following tests may be done:

1. General blood test: the number of eosinophils is usually elevated.

2. Skin prick tests (SkinPrickTests, SPT) and measurement of total and specific IgE in the blood serum: these tests check whether a food or environmental allergen is related to the etiology of atopic dermatitis, but mainly highlight the general allergenic background of the child and the possibility of future occurrence of other allergic manifestations, for example from the respiratory system.

3. Cultures of skin lesions: check for staphylococcal settlement mainly in patients with severe atopic dermatitis and in cases of contaminated lesions.

The course of atopic dermatitis in Greece is generally very good. Probably due to the sun, eczema is rarely difficult and as a rule does not persist for more than 4-5 years. A fundamental role in its treatment, however, is the good hydration of the skin and the application of topical medications (corticosteroids and calcineurin receptor blockers) to treat inflammation, especially when it is in flare- ups. Also of great importance are general measures to prevent atopic dermatitis flare-ups such as bathing at body temperature and with the addition of hydrophilic oil/use of hypoallergenic, special products, use of cotton fabrics, avoidance of chemical powder detergents, avoidance of foods with preservatives and colorings. Also, in the presence of a food allergy that may be associated with an eczema flare-up, appropriate dietary guidelines are given. It is stressed, however, that the likelihood of a food causing/exacerbating eczema is very low. Only about 10% of cases constitute what is called "food- dependent atopic dermatitis". In the presence of sensitizations to aeroallergens, measures are taken depending on the nature of these sensitizations. Overall, meticulous and daily skin care based on the above mentioned measures is the cornerstone for keeping eczema in remission.

The progression of atopic dermatitis varies, characterized by flares and remissions but, as mentioned above, is generally benign. It is usually the more severe and persistent the earlier in life it occurs and the less well treated in the early years. Due to the allergic underlying substrate and/or due to atopic dermatitis, up to 60% of children with atopic dermatitis will develop respiratory manifestations (allergic rhinitis, asthma). Unfavorable prognostic signs suggesting future persistence of allergy in general are the occurrence of severe eczema early in life, co-existing food allergies and a similar family history.

Vivi Magina
Pediatrician