Atopic Eczema

Atopic Eczema is commonly in infancy, and thus the term infantile eczema is used some authorities synonymously with atopic eczema. Atopic eczema is also reffered to as flextural eczema as the flexor aspects of the limbs are commonly affected. it should however,be remembered that atopic eczema can accur in adults and involve any part of skin.
The etiology of atopic eczema is multifactorial.Genetic factors are involved and there is a strong association with hay fever and asthma.

The possible abnormalities due to genetic factors are:
A defect in the stratum corneum (the skin barrier) leading to dryness of the skin and easier acces for chemical irritants and bacteria to penetrate into the skin.

A T helper cell type 2 cytokine response by infiltrating T lymposites.

Increased immunolglobulin E (IgE) pdoduction

Abnormality of the IgE receptor

impared response by the innate immune system.

The environmentals factors that may play a role in the etiology of atopic eczema include:

1. Pollution which has increased during the past 50 years
2. Micro organisms on the surface of the skin particularly staphylococcus aureus: in estabilished atopic eczema lesions, S aureus can be isolated in over 90% of patients
3. Lack of infective conditions in early life (the hygiene hypothesis)
4. Dietary and aero allergens : role of external allergens is difficult to establish with certainly becouse there are no reliable test.

Age incidence:
Atopic eczema is not present at birt and usually does not occur before the age of 3 months. common time of onset is during the first second years of life, although it may present for the first time later in childhood and rarely in adults.

Type of lesion
The typical physical sign are erythema, scalling and thickening of the skin. The features of eczema i.e. crusting and weeping, are not common but may accur, blisters are rare. Atopic eczema is very irritating condition and excoriations with bleeding are frequently seen. May also present with small fine papules on the trunk in addition to the more typical lesions described above.
Becouse of the excoriations and since, as in the most skin disorders, the protective function of the skin is lost,secondary bacterial infection is not uncommon. such infection may present as pustules or purulent custed areas.

Atopic eczema is assosiated with asthma and hay fever.The tree disorders together are referred to as the atopic syndrome,the atopic eczema syndrome is genetically conferred and there is frequently a positive family history of one of three complaints when a child with atopic eczema is seen for the first time.

Management and treatment: Topical treatment with steroids,topical pimecrolimus and tacrolimus safe for long term, emollients,topical antibiotics and antiseptics,sistemic therapy with: antihistamin,antibiotics,steroid. Phototherapy has been known for many years that sunlight helps chronic atopic aczema.