Atopic dermatitis (AD) can also "harass" your private parts, such as ***. These parts are always covered by clothing, not breathable, and irritated by urine, feces, etc., which is often not easy after the occurrence of atopic dermatitis**. Sometimes, the itching strikes suddenly, like a hundred claws scratching the heart, making people itch and not want to live. It's like "kraft candy", it can't be shaken off, and a bunch of questions biubiubiu pop up; Now to clear your doubts and introduce you to what is going on?
ONE Definitions. Atopic dermatitis, also known as atopic eczema, is a chronic refractory, **sexual, itching, inflammatory** disease, and patients often have allergic rhinitis and asthma.
The incidence of atopic dermatitis is on the rise worldwide, and the WHO Burden of Disease Study shows that the number of people with AD worldwide is as high as 2300 million, which is the first disease with the highest disease burden among non-fatal diseases. In our country, the number of patients with atopic dermatitis is also increasing year by year.
The impact of atopic dermatitis is not only physical, but also psychological, seriously affecting the patient's work, life and social life.
2. Pathogenesis.
Although the exact pathogenesis of atopic dermatitis is still unclear, current studies believe that factors such as immune abnormalities, barrier dysfunction, and microbiota disorders are important links in the pathogenesis of this disease, and the three aspects affect each other and cause each other. Immune abnormalities and barrier dysfunction make it easy for external environmental substances (such as allergens and microorganisms) to invade the epidermis and initiate an inflammatory response, and inflammatory factors can inhibit the expression of barrier-related proteins and further destroy barrier function.
The skin lesions and peripheral appearance of atopic dermatitis are normal**, often accompanied by **microflora disorders mainly manifested by increased colonization of Staphylococcus aureus and decreased microflora diversity, as well as the resulting metabolic and other functional abnormalities, which promote the progression of **inflammation. Repeated scratching is an important cause of aggravation and persistence of inflammation, which not only promotes the production of inflammatory mediators by keratinocytes, but also leads to the release of autoantigens, resulting in an abnormal immune response to autoantigens. Non-immune factors, such as neuro-endocrine factors, can also be involved in the development and progression of inflammation.
3. The incidence of atopic dermatitis is closely related to genetic and environmental factors. Genetic factors are the strongest risk factor for this disease, and it is important to pay attention to whether the patient's parents and other family members have a history of allergic disease. Genetic factors affect the patient's barrier function and immune balance.
The impact of environmental factors is multifaceted, including external climate change, infectious and allergen stimuli, etc.; Allergens (such as dust mites, cat hair, dog hair, pollen, etc.), microorganisms (such as bacteria (such as Staphylococcus aureus), fungi (such as Malassezia), etc.), food (such as hot drinks, spicy food, alcohol lamps), sunlight, excessive bathing, etc.
Among them, mental factors, sweating, colonization of Staphylococcus aureus, and exposure to dust mites are the most common predisposing factors. The predisposing factors of different patients are quite different, and the inducements of others are not equal to their own predisposing factors, so they should pay attention to the observation in daily life and clarify their own individual predisposing factors, so as to effectively avoid them.
4. How to make a preliminary judgment for yourself?
Atopic dermatitis usually refers to what the common people call eczema, also known as atopic eczema. Atopic dermatitis is often genetically predisposed and has a variety of manifestations, and some can also be combined with diseases such as asthma and allergic rhinitis, which is often chronic.
The basic features are chronic eczema-like lesions, dryness, and marked pruritus. It is a chronic refractory, **sexual, itching, inflammatory ** disease. Although atopic dermatitis is more complicated than ordinary eczema, it is not difficult to tell. If we want to know if we have atopic dermatitis, we can start by asking ourselves three questions.
1) Is eczema still not good for half a year?
If it is ordinary eczema, it generally does not last too long, so if you find that eczema is not good and persists for more than 6 months, you should suspect atopic dermatitis.
2) In addition to the ** symptoms, is there also a combination of diseases of other organs?
If you find that you have dermatitis at the same time, you also have allergic rhinitis, allergic asthma, or when the seasons change, you will have sneezing, runny nose, bad state, and easy allergies, etc., it is also suspicious.
China's research data show that 167% of patients with atopic dermatitis also have asthma, 337% also had allergic rhinoconjunctivitis. In addition, patients with chronic disease are at increased risk of developing neuropsychiatric disorders, inflammatory bowel disease, rheumatoid arthritis, cardiovascular disease, and lymphoma.
3) Is there anyone in the family who has this disease?
There is a very heart-wrenching reality - atopic dermatitis, which has a certain genetic predisposition, but is not contagious!
Studies have shown that about 70% of patients with atopic dermatitis have a family history of "atopic disease";
If one or both parents have atopic dermatitis, the chance of developing atopic dermatitis in the next generation increases by 3 times!
There may even be intergenerational inheritance. If there are more than two people in a family with allergic diseases, then it is likely that there is a problem.
Pro tip. If the patient presents with eczema-like skin lesions, the possibility of AD should be suspected, and a detailed medical and family history should be sought, and the diagnosis should be made in combination with clinical manifestations and a comprehensive physical examination. Peripheral blood eosinophil count, serum total IgE, allergen-specific IgE, and allergen screening should be done if necessary.
In practice, diagnostic criteria that facilitate clinical practice can be chosen, such as the following 1+2 or 1+3 to be used to diagnose AD
1.course of the disease: symmetrical eczema for 6 months;
2.personal and/or family history of atopy;
3.Elevated serum total IgE or elevated peripheral blood eosinophils and/or positive for more than one specific IgE. Interpretation of allergen-related index test results.
Elevated serum total IgE indicates atopic sensitivity, and specific IgE assists in determining allergens, and simultaneous detection of both indicators is recommended.
The value of specific IgE (Sige) is more than 035 kul is defined as positive, but it is not positive and allergic, and needs to be judged in combination with history and clinical manifestations. In general, the higher the SIGE value, the more likely it is to have allergies.
5. So how can you tell the severity of atopic dermatitis?
The manifestations of atopic dermatitis are varied, and can be very mild eczema, eczema plus allergic rhinitis, eczema plus allergic asthma, very complex. So how can you tell the severity of atopic dermatitis?
mild atopic dermatitis: rash area < 5 body surface area;
Moderate atopic dermatitis: rash with an area of more than 5 body surface area but less than 10 body surface area;
Severe atopic dermatitis: greater than 10 body surface area.
6. Differential diagnosis.
The differential diagnosis of atopic dermatitis is mainly distinguished from inflammatory diseases with polymorphic skin lesions such as erythema, papules, plaques, etc., such as seborrheic dermatitis, contact dermatitis, psoriasis, ichthyosis, and scabies. The specific identification points are as follows:
1.Seborrheic dermatitis: a chronic inflammatory disease that tends to occur in the head, face, chest and back, and other parts of the sebaceous glands, which can have erythema, papules, scaling, greasy, and often accompanied by itching.
2.Contact dermatitis: It is an inflammatory reaction that occurs mainly at the contact site after exposure to external substances. Presents with erythema, papules, swelling, blisters, and even bullae, which may be accompanied by itching or even stinging or pain. However, atopic dermatitis lesions are diverse and ill-defined, which is a key point to distinguish them from contact dermatitis.
3.Psoriasis: commonly known as psoriasis, the typical clinical manifestation is **erythema surface covered with silvery-white scales, and punctate bleeding and film phenomenon can be seen after scraping off the scales. A small number of patients may present with pustules, joint lesions, or other systemic symptoms.
4.Ichthyosis: caused by multilineage genetic factors, early onset, mainly manifested as dry and rough extensor sides of the limbs or trunk**, accompanied by diamond-shaped or polygonal scales, and the appearance of fish scales or snakeskin. The cold and dry seasons are aggravated, and the warm and wet seasons are relieved.
5.Scabies: It is a contact infectious disease caused by scabies mites in the epidermal layer of the human body. Epidemics can be transmitted between households and contacts. The clinical manifestations are characterized by soft places such as papules, blisters and tunnels between the fingers, pruritic nodules, and increased itching at night.
7. How is atopic dermatitis**?
Atopic dermatitis is not an infectious disease and cannot be transmitted to or by others, but it has a certain genetic predisposition.
Different options are chosen according to the patient's condition, and the foundation is the cornerstone of all. The basics** include proper bathing, emollient repair** barrier, avoiding allergen irritation and reducing man-made irritation.
a) Topical medications**.
1.Topical glucocorticoids (TCS): is the first-line of AD, according to the patient's age, the nature of the lesion, the location and the degree of the disease to choose different dosage forms and strength of TCS, long-term large-scale use may lead to ** and systemic adverse reactions, here to advise the patient to be in accordance with the doctor's instructions, standardized medication can largely avoid adverse reactions, talking about hormone discoloration is also not advisable. Topical corticosteroids of sufficient intensity should be used initially to achieve rapid control of inflammation within a few days, followed by a gradual transition to moderate-to-low glucocorticoids or calcineurin inhibitors.
Site selection principle: **Short-term use of moderately weak glucocorticoids.
Active maintenance**: Patients with moderate to severe or atopic dermatitis should transition to long-term active maintenance ** after skin lesions are controlled, and the drug is a moderately weak glucocorticoid or calcineurin inhibitor.
2.Topical calcineurin inhibitors: also important anti-inflammatory drugs for **AD, recommended for use in thin and tender areas or for active maintenance of **decrease**; Mild inflammation and pruritus are controlled or used to actively maintain **reduction**. Pimecrolimus 1% cream is mostly used in patients with mild to moderate disease, 003% (for children) vs. 0Tacrolimus ointment 1% (* with) is used in patients with moderate to severe disease.
Calcineurin inhibitors are contraindicated in patients with a history of allergy to the drug or any other component of the formulation, and large-scale use should be avoided, especially in immunocompromised patients** and children. If symptoms and signs do not improve within 6 weeks, the patient should be examined and the ** regimen adjusted. Before starting a calcineurin inhibitor**, the foci of infection, such as localized bacterial or viral**, should be eliminated first.
The adverse reactions are mainly local burning and irritation, and the ointment can be refrigerated in the refrigerator before being used to reduce the irritation, and the irritation can gradually disappear with the increase of the number of medications. In patients who are acutely or partially intolerant of drug stimulation, it is recommended that acute symptoms be controlled with a short course of topical corticosteroids and then maintained with a calcineurin inhibitor**. Long-term use of such drugs will not destroy the barrier and cause atrophy and other reactions.
3.Other external drugs: zinc oxide oil (paste), black soybean distillate ointment, etc. are effective for atopic dermatitis with a small amount of exudation; Exudation in the acute phase can be treated with topical saline or 3% boric acid solution and other drugs; Novel small-molecule topicals targeting inflammatory mediators in atopic dermatitis, such as topical phosphodiesterase-4 (PDE4) inhibitors (cliborol ointment), can be used in mild-to-moderate patients aged 2 years and older.
ii) System**.
1.Oral antihistamines: For patients with allergic comorbidities such as urticaria and allergic rhinitis, it is recommended to use second-generation non-sedating antihistamines**, commonly used drugs are loratadine, cetirizine, etc., and a new generation of antihistamines derived from them, such as desloratadine, desloratadine, lupatadine, levocetirizine, etc., the initial dose follows the recommended dose of the instructions, if the efficacy is not good, the dose can be doubled after full communication with the patient; Two different types of antihistamines may also be used in combination to improve efficacy.
First-generation antihistamines, such as diphenhydramine, chlorpheniramine, and promethazine, may be tried in patients with significant pruritus or sleep disturbances, and long-term use is not recommended, especially in children, given the effects of first-generation antihistamines on sleep quality (delayed and reduced REM) and learning and cognitive ability.
2.Immunosuppressants: such as cyclosporine, methotrexate, azathioprine, etc., suitable for patients with severe AD and routine ** is not easy to control, the application of immunosuppressants must pay attention to the indications and contraindications, and adverse reactions should be closely monitored;
3.Systemic glucocorticoids: In principle, they should not be used or used sparingly, and can be used for a short period of time in patients with severe conditions and acute attacks that are difficult to control with other drugs. The recommended dose is 05 mg·kg-1·d-1 (based on prednisone), and the dose should be reduced and discontinued in time after the condition improves. Long-term systemic corticosteroids should be avoided to prevent adverse effects such as infection, elevated blood glucose, central obesity, and osteoporosis.
4.Biologics: Drugs** have entered a new era of biologics, and the biologics dupilumab (Dalbital), which primarily targets atopic dermatitis, has brought a boon to patients with moderate to severe atopic dermatitis. Dabital is the first targeted biologic agent for atopic dermatitis that provides rapid relief of itching, skin lesions, disease severity and quality of life.
At present, dupilumab has been approved for children aged 6 years and older with poor topical control or not recommended for topical use and moderate to severe atopic dermatitis, and is recommended as a first-line systemic drug for moderate to severe atopic dermatitis, which has been widely used in Western clinics for many years, with high safety, easy to use, and can be used for long-term maintenance. In addition, new small molecule drug JAK inhibitors have also shown good efficacy in moderate to severe AD.
Approved in 2022 for patients aged 6 years and older with AD who are poorly controlled by topical medication or are not recommended to use topical medication; Dupilumab is administered subcutaneously, with a recommended initial dose of 600 mg, followed by 300 mg once every two weeks, adjusted according to body weight for children aged 6 to 17 years; **Generally effective, it takes about 4 to 6 weeks, but the onset time of action varies from patient to patient; Clinical data showed that approximately 80% of AD patients achieved 50% remission in eczema area and severity after 16 weeks of using dupilumab. Most of the adverse reactions of dupilumab are mild or moderate, such as local reactions at the injection site, conjunctivitis, oral herpes, etc.
Pro tip. Generally speaking, although the symptoms of ** patients disappear, it is generally recommended to continue to use the medicine every other day, or use the drug 2-3 times a week, such as once a week on Wednesday and once a Saturday, although the drug is used in very small amounts, but it can also work.
3) Itching**: Itching is the most important symptom of atopic dermatitis, and controlling itching can block the vicious circle of "itching-scratching-atopic dermatitis aggravation", and emollients, antihistamines, topical anti-inflammatory drugs, systemic anti-inflammatory drugs, phototherapy, etc. have good effects on itching. Patients with mild pruritus are mainly topical, including emollients containing antipruritus, moderately weak glucocorticoids, and calcineurin inhibitors, and oral antihistamines are selected as appropriate. Patients with moderate itching should be treated with glucocorticoid wet pack**, and if there is no obvious effect on 3 or 5 days, oral mirtazapine can be used, and if the effect is still poor, it can be combined with gabarcardin or pregabalin. Patients with severe intractable pruritus should be referred to **specialist**.
4) Antimicrobial**: Focus on the effects of bacterial (increased colonization of Staphylococcus aureus), virus (herpetic eczema, etc.), fungi (Malassezia may be involved in the pathogenesis) infection, and only use the corresponding drugs for systemic or topical use for a short time when there are obvious signs of infection.
8. What should patients with atopic dermatitis pay attention to?
Patients should have sufficient understanding of the factors that cause and aggravate atopic dermatitis, and the main points can be described in the simplest six words, that is, clothing, food, housing, transportation, washing, and comfort.
1.Clothing. Tactile stimuli caused by friction, such as "beauty" (tight and irritating clothing), can lead to atopic itching, which promotes neurogenic inflammation and scratching, which leads to **.
Patients with atopic dermatitis tend to be drier and more sensitive, so it is recommended that patients should wear cotton loose clothes as much as possible.
2.Food. Depending on the situation of your own allergens, you should not eat anything you are allergic to. It should be noted that blind food avoidance is not recommended unless there is a clear causal relationship between food and rash, as excessive food avoidance is not only not beneficial to atopic dermatitis, but can also lead to malnutrition in patients.
3.Live. Many patients with atopic dermatitis have respiratory tract involvement, so it is recommended that the house decoration must be green and healthy to avoid irritation of the respiratory tract by benzene and formaldehyde. Avoid excessive dryness and high temperature and other irritation, suitable for living temperature of 18 22; It is also not recommended to have allergenic pets at home, it is best not to lay carpets, and the bed sheets and quilts should be changed once a week.
4.Yes. It is best not to go to places that are easy to aggravate symptoms, such as when the patient is aggravated by sunlight, so avoid light; If the patient gets worse in spring, there must be some kind of allergen in the outside world, so pay attention to parks, botanical gardens, zoos, and home improvement markets.
5.Wash. Fueling the flames".
Sweat is often thought of as an aggravating factor in the "itch-scratch" cycle of atopic dermatitis. There are several reasons for this:
When sweating, it is easy to have local ** impregnation friction stimulation due to the increase of friction;
Sweat is weakly alkaline, which will increase the pH of the surface, weaken the acidic barrier effect on external microorganisms, and proliferate local abnormal flora, causing **infection, resulting in**;
Sweat stays for a long time, and the allergens in sweat play a pro-inflammatory role, resulting in **.
Collect "Tricks: So easy! Take a bath in time, be careful not to over-wash, wash once a day or every other day, it is recommended that the bathing temperature is 32 37 °C, the bathing time is 5 10min, the bath liquid is acidic, if the skin lesions have a tendency to infect, sodium hypochlorite (0005% Bleach Powder Bath) to inhibit bacterial activity and help relieve itching caused by atopic dermatitis.
Moisturizing emollients should be used in a timely, correct and sufficient amount after bathing to reduce the amount of transepidermal water loss, improve symptoms such as itching and dryness, and promote barrier repair.
Tip takeaway: Principles for using functional skincare products.
Dosage form selection: The commonly used dosage forms are emulsion and cream, which need to comprehensively consider the individual differences of patients, ** status, season, climate and other factors. As far as the season is concerned, considering the high moisturizing degree of the cream, it is generally used in winter and in spring and autumn in the north; The emulsion has a good moisturizing effect and is suitable for summer and spring and autumn use in the south. Wrinkles, sweating and other parts can be appropriately reduced or choose a thinner dosage form than the limbs.
Frequency and dosage: It is recommended to use emollients 1 2 times a day for **care, and the number of uses can be increased appropriately for skin lesions or dry areas. The recommended weekly dosage** is 250 500 g and 100 250 g for children.
Sequential combination with topical agents**: The order in which emollients and topicals are used is not associated with efficacy. In the advanced stage of atopic dermatitis, use functional skin care products in combination with topical drugs**; When you enter the recovery period, reduce or stop topical medications, and simply apply topical moisturizing skin care products to prevent disease**.
Some of the traditional ingredients in moisturizing skincare products, such as propylene glycol and high concentrations of urea, are irritating and toxic and should be avoided in children under 2 years of age. Some pure oil-based skin care products containing ingredients such as olive oil and coconut oil are not recommended for external use due to their high oleic acid content, which will increase transepidermal water loss. Allergens (e.g., peanuts, oats, etc.) and hapten components (lanolin, methylisothiazolinone, etc.) that provide nitrogen in the form of intact protein should be avoided to avoid increasing the risk of allergies.
6.Unfold. Relatives and friends should be less blamed and discriminated against, and more understanding and help to the patients, so that they can stay happy and happy and get through every difficult moment of the disease. Stress, anxiety, depression, and excessive psychological stress may aggravate atopic dermatitis.
Collect "cure tricks": As the saying goes, diseases should be treated by "three points of treatment, seven points of nourishment". Be in a good mood and participate in outdoor activities when the air and sunshine are right. However, if you have pollen allergies, remember to avoid the park where the flowers are in full bloom and go camping in the green meadows. Cultivate a hobby of your own, which can be reading, painting, sports, yoga and other activities that are beneficial to physical and mental health.