Symptoms of atopic dermatitis

Atopic dermatitis is a multifactorial disease that has a chronic recurrent course with pathologically altered immune responses and a multivariate pattern of clinical manifestations. It is a fairly inflammatory skin disease with a strong itch that is associated with hereditary factors and is often found in the patient's family or is accompanied by other immediate types of atopic diseases such as allergic rhinitis, allergic conjunctivitis and allergic bronchial asthma. Morphological severity of the disease usually changes depending on the age of the patient and the severity of skin manifestations.

Atopic dermatitis can become generalized, often there are secondary bacterial infections and lymphadenitis. Frequent use of external drugs exposes the patient to various allergens, with the possible exacerbation of contact dermatitis, which leads to complications of atopic dermatitis.

Constant signs of atopic dermatitis

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

Frequent symptoms of atopic dermatitis

• Skin Infections
• Early start
• Elevated serum IgE
• Nonspecific dermatitis of hands and feet
• Positive skin tests of type 1 allergy
• Xerosis

Rare signs of atopic dermatitis

• Cataract (anterior subcapsular)
• Erythema of the face
• Intolerance to certain foods
• Ichthyosis
• Folding of the lower eyelid
• Itching with sweating
• Keratoconus (conical protrusion of the cornea)
• Eczema nipples
• White lichen
• Recurrent conjunctivitis
• White dermographism
• Intolerance to wool

For diagnosis, there are three permanent signs or more plus three or more frequent or rare signs.

The characteristic features of atopic dermatitis are severe itching and clinical polymorphism, which determine the variety of clinical forms of the disease, and therefore there are certain difficulties in diagnosing the disease. Atopic dermatitis begins at an early age and has a staged flow, clinical features in different age periods.

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

In the initial stage of atopic dermatitis, as a rule, children develop from 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 organism 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. The peculiarity of the initial stage is its reversibility under the condition of timely begun treatment.

In the acute stage, erythematous spots with fuzzy boundaries, papules, microvesicles, erosions, peels, and scaling against the background of widespread edema are noted. Due to severe itching, traces of scratching (excoriation) are visible, secondary infection is often attached and pustules are formed. Regional lymphadenitis and lymphangitis can also occur. At a chronic stage because of constant combing and grinding the skin thickens, all the drawing is amplified (lichenization). On the surface of the lichen focus there are excoriations, brown or yellow-brown crusts, painful cracks, especially in skin folds, palms and soles. Outflow of the outer third of the eyebrows and hyperpigmentation of the eyelids are noted - the result of combing the eyes. A fold of the skin under the lower eyelid is characteristic.

During the period of remission, the symptoms of dermatitis decrease or disappear. The period of remission lasts from several weeks to several years. If you do not carry out the appropriate treatment and preventive measures, then atopic dermatitis can occur without remission.

Favorite locations of localization are the anterior and lateral surfaces of the neck, the face, the flexion surfaces of the joints, the back surface of the hands and feet. When the generalized form affects the entire skin. Depending on the age, infants (between the ages of 2-3 months to 3 years), children (from 3 to 12 years) and adolescent (from 12 to 18 years) forms of atopic dermatitis are distinguished.

[1], [2], [3], [4], [5], [6]

Symptoms of atopic dermatitis in various periods of the disease

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

• The first period - up to 3 years (thoracic and early childhood).
• The second period is junior preschool, school and adolescence.
• The third period is puberty (adolescent) and adult.

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

1. Clinic manifestations of the I age period. Acute and subacute-inflammatory nature of lesions with a tendency to exudative changes; a certain type of localization on the face; with disseminated process - preferential localization on the outside of the limbs; the greatest dependence on alimentary irritants and the severity of the allergic (food allergy) component among the risk factors of manifestation.
2. Clinic manifestations of the II age period. Localization in folds; chronic inflammatory nature of lesions with more pronounced lichenoid syndrome; development of secondary changes (dyschromia); manifestation of autonomic dystonia; remittent flow with a regular waviness; reaction to many provoking effects with a decrease in alimentary hypersensitivity.
3. Clinic manifestations of the III age period. Change in the localization of lesions that lose folded confinement; more pronounced hyperplastic and infiltrative nature of lesions with a lesser tendency to acute inflammatory manifestations and an increase in lichenoid syndrome; less noticeable reaction to allergenic stimuli; less clear seasonality of undulation.

As the age of patients increases, the number of exudative foci decreases, and lichen-induced skin manifestations increases. In any age period, there may be an increasing number of skin lesions, and the disease can eventually move into a generalized form. Secondary development of atopic erythroderma. The parameters of eosinophilia in the blood are repeatedly increased.

Concomitant 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 the childhood period.

[7], [8], [9], [10], [11],

Eye Diseases

They can manifest as a neurodermic cataract, keratoconus, or non-allergic keratoconjunctivitis. Isolated atopic blepharitis is also possible. Cataracts are rare (<5%) and more common in children and adolescents. Sometimes they describe Ablatio retinae.

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

[12], [13]

Diagnostic criteria of atopic dermatitis

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

The mandatory criteria include: itching of the skin; typical morphology and localization of skin rashes; chronic recurrent course; atopy in the anamnesis or hereditary predisposition to atopy.

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

For the diagnosis of atopic dermatitis, three or more mandatory and three additional signs are sufficient.

[14], [15], [16], [17], [18], [19], [20]