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 majority of the cases, but it may start at any age, even before the age of 2 months in some cases.
• Although it often improved 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 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

• 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)

Course of atopic dermatitis may be divided in 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 hyper pigmentation 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 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
• Skin care

Internal medicines

• Guduchyadi kashaya
• Patola katurohinyadi kashaya
• Sudarshana gutika – if pain is present
• Guggulupanchapala choorna with madhu
• Doosheevishari gutika
• Rajanyadi choorna
• Haridra khanda
• Madhusnuhi rasayana
• Manibhadra guda
• Mahatiktaka ghrita

External

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