ATOPIC DERMATITIS

• Atopic Dermatitis is a common chronic or relapsing dermatitis characterized by severe pruritis, occurring primarily in infants and children. The age of onset is between 2 and 6 months in the majority of cases, but it may start at any age, even before the age of 2 months in some cases
• Although it often improves during adolescence, it may also become a chronic condition that extends into adulthood. Atopic dermatitis is often associated with atopic diseases such as asthma or allergic rhinitis 

• The disease arises as a result of a complex interplay between various genetic, immunological, and environmental factors
• Environmental factors: Physical factors like sweating, climate, warm surroundings, detergents and soaps, synthetic or woolen fabrics, cigarette smoking
• Genetic factors: Inherited predisposition for increased IgE formation and sensitization (Type 1 hypersensitivity)
• Food items –including tomato, orange, citrus fruits, juice, meat, fish
• Allergens: house dust mite, animal hair, pollen, plants, and others such as staphylococcal aureus

• The main symptom is intense pruritis and dry skin
• Typical morphology and distribution ( Flexural lichenification or linearity in adults; facial and extensor involvement in infants and children)
• Chronic or chronically relapsing dermatitis
• Personal or family history of atopic dermatitis( e.g asthma, allergic rhinitis, atopic dermatitis)

The course of atopic dermatitis may be divided into three phases: Infantile phase, Childhood phase, and Adult phase 

• Infantile phase: Face and scalp involvement is common as well as the extensor surfaces of the extremities and trunk
• Childhood phase: Eczema is observed on the flexural surfaces, including the neck, antecubital or popliteal fossae, wrists, and ankles
• Adult phase: Lichenification of the flexures and hands commonly occurs 

Associated findings

• Atopic triad of asthma, allergic rhinitis, and atopic dermatitis that is linked to allergen triggered IgE, White dermographism ( transiently blanched skin), Dermatographism, Keratosis pillaris( keratinized hair follicles), xerosis, Ichthyosis

Important signs

• Hertoghe’s sign( thinning of lateral eyebrows), Hyperkeratosis, and hyperpigmentation producing a dirty neck appearance. Atopic individuals often exhibit perioral, perinasal, and periorbital pallor “headlight sign”

Differential diagnosis

• Seborrheic dermatitis – Lesions are usually dry in atopic dermatitis and more greasy in seborrhic dermatitis. The most useful distinguishing feature in seborrhic dermatitis is the increased number of lesions on the axilla
• Psoriasis: onset is usually after adolescent years and lesions are typically covered with white silvery scales, located on the extensor surface 
• Infectious conditions: Mycoses, scabies 

• Usually based on patient history and clinical appearance 
• Essential features – Pruritis and Eczema 
• Hanifin and Rajka’s criteria
• IgE
• Eosinophilia
• Patch testing

Avoidance of Triggers

• Air conditioning
• Cutting of nails
• Cotton and loose-fitting clothes 
• Use of less alkaline soaps
• Skincare 

Ayurvedic Treatment

Snehana

• Thiktaka gritha
  • Up to 1 year: given as drops: always one should have a proper assessment of agni before administering sneha kalpana - 2 drops to 5 drops depending on agni
  • Above 1 year: always start with a minimum dose- even 2 drops will be sufficient to get the desired effect
  • Properly monitor the status of agni and increase the dose

Koshta sudhi

• Avipathi Choorna
  • 2to 5 years: ½ to ¼ tsp
  • 5 to 10 years: ½ tsp – 1 tsp

Samana yogas  

• Makkipoovadi kashaya, Thiktakam kashaya ,Nimbadi kashaya
• Gopeechandanadi gutika
• Rajanyadi Choorna (Infant: 2-3gm, Toddler- 5gm, School going- 7-10gm)

External

• Guduchi kashaya/ Triphala kshalana
• Rasottamadi lepa
• Eladi taila, Paranthyadi taila Dhara
• Dineseladi / Neeli tailam / Sudhadoorvadi kera for ext application