Supporting Children with Atopic Dermatitis Through Growth – The Itchy Challenge of Atopic Dermatitis
Update Date：2024/08/05，
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Mei-Mei, an eleven-year-old girl, has been suffering from the itchiness of eczema since childhood. She itches, scratches, breaks her skin, and bleeds daily, with affected areas covering her ankles, behind her knees, and the crooks of her elbows. Every day, her bed is filled with skin flakes and bloodstains. At the beginning of the school term, she had to visit the hospital due to an infection caused by her scratching wounds. Besides frequently taking leave from school due to her skin condition, the various eczema lesions, wounds, scars, and scratch marks on her skin make her the subject of strange looks and even bullying. As a result, Mei-Mei does not enjoy going to school.
Atopic dermatitis is one of the most common chronic skin conditions in children and often the first manifestation of allergies. Patients frequently have a history of allergic rhinitis or asthma, and it is common for family members to have a history of allergic rhinitis, asthma, or atopic dermatitis. Atopic dermatitis typically appears in early childhood, with about 80% of cases occurring before the age of six. Compared to the past, its prevalence is increasing.
Atopic dermatitis is caused by multiple factors. The interaction between genetic and environmental factors leads to the condition. An allergic predisposition results in abnormal skin barrier function (increased water loss, reduced water content in the stratum corneum, and decreased skin lipid content, causing dry skin and making it easier for environmental allergens to penetrate). In addition, environmental stimuli (such as allergens, dust mites, air pollution, food allergies, bacteria, sweat, etc.) trigger inflammatory responses, leading to tissue damage and a type 2 inflammatory response.
Atopic dermatitis is diagnosed based on clinical evaluation. There is currently no blood test that can directly diagnose atopic dermatitis. The primary clinical manifestations include:
1. Itchy skin.
2. Typical morphology and distribution of eczema (e.g., lesions on the scalp, face, ears, trunk, and extensor surfaces of the joints in infants).
3. Chronic, recurrent eczema.
4. A personal or family history of atopic conditions.
The most important aspect of treating atopic dermatitis is repairing the skin. This involves applying lotion, cream, or ointment to the entire body three to four times daily. Additionally, bathwater should not be too hot, and bathing should not be prolonged.
Avoiding allergens and irritants is also crucial. Maintaining a clean home environment, including removing dust mites and dust, is important. Sweat can be an irritant, so showering or wiping down with a towel and changing into clean clothes after sweating is recommended. Stress and emotions are common triggers; moderate exercise can help regulate emotions and relieve stress. If food allergies are present, the offending foods should be avoided.
The primary medication treatment for atopic dermatitis involves topical corticosteroid ointments. Additionally, topical immunomodulators such as tacrolimus (Protopic) and pimecrolimus (Elidel) ointments are available. A newer ointment, crisaborole (Eucrisa), has emerged in recent years and can reduce steroid use, offering effectiveness comparable to or slightly lower than medium-potency corticosteroids. Its advantage is minimizing steroid side effects, such as skin thinning, making it suitable for use on thinner skin areas like the face and flexural areas (e.g., groin, armpits). Oral corticosteroids are typically used short-term during acute flare-ups. Other treatments, such as oral immunomodulatory drugs and phototherapy, are used for moderate to severe cases or when large areas are affected and the aforementioned treatments are ineffective. If these treatments still do not improve the condition, biologic injections or oral small-molecule drugs may be considered.
Living with atopic dermatitis is a long journey for both patients and caregivers. With persistent effort, improvement is possible.
Dr. Ya-Ling Chou from the Pediatric Allergy, Immunology, and Rheumatology Department