Symptoms of atopic dermatitis

Atopic dermatitis is a multifactorial disease with a chronic relapsing course with pathologically altered immune responses and a multivariate picture of clinical manifestations. It is a rather diverse morphological aspect and general course of an inflammatory skin disease with severe itching, which is associated with hereditary factors and is often found in the patient's family or is accompanied by other immediate-type atopic diseases, such as allergic rhinitis, allergic conjunctivitis and allergic bronchial asthma. The morphological severity of the disease usually changes depending on the patient's age and the severity of skin manifestations.

Atopic dermatitis can become generalized, secondary bacterial infections and lymphadenitis are common. Frequent use of topical agents exposes the patient to various allergens, and contact dermatitis may worsen, leading to complications of atopic dermatitis.

Constant signs of atopic dermatitis

• Chronic or chronically recurring disease
• Hereditary predisposition to allergic diseases
• Itching
• Typical morphology and localization:
• Eczema of the face and flexural surfaces in infants and children
• Eczema in the folds of adults

Common Signs of Atopic Dermatitis

• Skin infections
• Early start
• Elevated serum IgE levels
• Non-specific dermatitis of the hands and feet
• Positive skin tests for type 1 allergy
• Xerosis

Rare signs of atopic dermatitis

• Cataract (anterior subcapsular)
• Erythema of the face
• Intolerance to certain foods
• Ichthyosis
• Lower eyelid folds
• Itching when sweating
• Keratoconus (conical bulging of the cornea)
• Nipple eczema
• White lichen
• Recurrent conjunctivitis
• White dermographism
• Wool intolerance

Diagnosis requires three or more constant features plus three or more common or rare features.

Characteristic features of atopic dermatitis are severe itching and clinical polymorphism, which determine the diversity of clinical forms of the disease, which is why certain difficulties arise in diagnosing the disease. Atopic dermatitis begins at an early age and has a staged course, clinical features in different age periods.

Currently, the following stages of atopic dermatitis development are distinguished: initial, stage of pronounced skin changes (acute and chronic phases) and stage of remission.

In the initial stage, atopic dermatitis usually develops in children aged 2 to 6 months with an exudative-catarrhal type of constitution, characterized by hereditary, congenital and acquired features of immunobiological, neurovegetative and metabolic functions that determine the predisposition of the body to the development of allergic reactions. The earliest and most common symptoms of skin lesions are hyperemia and swelling of the cheeks and buttocks, accompanied by slight peeling. A feature of the initial stage is its reversibility, provided that treatment is started in a timely manner.

In the acute stage, erythematous spots with blurred borders, papules, microvesicles, erosions, crusts, peeling against the background of widespread edema are observed. Due to severe itching, traces of scratching (excoriation) are visible, a secondary infection often joins in and pustules are formed. Regional lymphadenitis and lymphangitis may also be observed. In the chronic stage, due to constant scratching and rubbing, the skin thickens, its pattern intensifies (lichenification). On the surface of the lichenified lesion there are excoriations, brown or yellow-brown crusts, painful cracks, especially in the skin folds, on the palms and soles. Loss of the outer third of the eyebrows and hyperpigmentation of the eyelids are noted - the result of scratching the eyes. A fold of skin under the lower eyelid is characteristic.

During the remission period, the symptoms of dermatitis decrease or disappear. The remission period lasts from several weeks to several years. If appropriate treatment and preventive measures are not taken, atopic dermatitis may proceed without remission.

Favorite localization sites are the front and side surfaces of the neck, face, flexor surfaces of joints, dorsal surfaces of the hands and feet. In the generalized form, the entire skin is affected. Depending on age, infantile (from 2-3 months to 3 years), childhood (from 3 to 12 years) and adolescent (from 12 to 18 years) forms of atopic dermatitis are distinguished.

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Symptoms of atopic dermatitis at different stages of the disease

During the course of atopic dermatitis, three age periods or phases of the disease are distinguished.

• The first period is up to 3 years (infancy and early childhood).
• The second period is early preschool, school and adolescence.
• The third period is puberty (adolescence) and adulthood.

The symptoms of atopic dermatitis in each of these three periods have certain distinctive features associated not with the duration of the disease, but with the age of the patient.

1. Clinical manifestations of the first age period. Acute and subacute inflammatory nature of lesions with a tendency to exudative changes; a certain type of localization on the face; in the case of a disseminated process - predominant localization on the outer side of the extremities; the greatest dependence on alimentary irritants and the severity of the allergic (food allergy) component among the risk factors for manifestation.
2. Clinical manifestations of the second age period. Localization in folds; chronic inflammatory nature of lesions with a more pronounced lichenoid syndrome; development of secondary changes (dyschromia); manifestation of vegetative dystonia; remittent course with regular wave-like behavior; reaction to many provoking influences with a decrease in alimentary hypersensitivity.
3. Clinical manifestations of the third age period. Change in the localization of lesions, losing their folded confinement; more pronounced hyperplastic and infiltrative nature of lesions with a lesser tendency to acute inflammatory manifestations and increased lichenoid syndrome; less noticeable reaction to allergenic irritants; less clear seasonality of wave-like behavior.

With increasing age of patients, the number of exudative foci decreases, and lichenified skin manifestations increase. At any age, an increasing number of skin lesions may occur, and the disease may eventually become generalized. Atopic erythroderma develops secondarily. Blood eosinophilia indices are increased many times.

Associated symptoms of atopic dermatitis

Allergic conjunctivitis, allergic rhinitis, hay fever and/or allergic bronchial asthma. These diseases occur in 30-50% of patients with atopic dermatitis and develop most often after childhood.

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Eye diseases

They may present as neurodermic cataracts, keratoconus, or nonallergic keratoconjunctivitis. Isolated atopic blepharitis is also possible. Cataracts are rare (< 5%) and are more common in children and adolescents. Ablatio retinae is sometimes described.

An increase in infraorbital folds (Denny-Morgan line, infraorbital Denny-Morgan fold) is an important sign of atopic disease; in atopic dermatitis, the atopic fold occurs in 70% of cases.

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Diagnostic criteria for atopic dermatitis

Currently, there are mandatory and additional criteria for the diagnosis of atopic dermatitis.

Mandatory criteria include: itching of the skin; typical morphology and localization of skin rashes; chronic relapsing course; history of atopy or hereditary predisposition to atopy.

Additional criteria include: xerosis (dryness) of the skin; palmar ichthyosis; immediate reaction to skin testing with allergens; localization of the skin process on the hands and feet; cheilitis; nipple eczema; susceptibility to infectious skin lesions; onset of the disease at an early age; erythroderma; recurrent conjunctivitis; Denier-Morgani folds (suborbital folds); keratoconus (conical protrusion of the cornea); anterior subcapsular cataract; cracks behind the ears; high levels of IgE in the blood serum.

To diagnose atopic dermatitis, the presence of three or more mandatory and three additional signs is sufficient.

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