ATOPIC DERMATITIS

What is atopic dermatitis?

What you should know about atopic dermatitis: Atopic dermatitis is a chronic or chronically recurring inflammatory skin disease associated with severe itching and usually occurring in bouts. The intensity of the symptoms depends partly on the age of the affected person and can severely limit quality of life. Atopic dermatitis is NOT a contagious disease. While it is considered incurable, it is very treatable, so that a reduction in itching and dry skin can be achieved through a wide variety of treatment options.

Neurodermatitis – a widespread problem

Around four million people in Germany alone suffer from atopic dermatitis. Almost one-eighth of the population in Western industrialized nations is diagnosed with this condition. The disease usually develops in young children and tends to improve with age. In some cases, symptoms are very mild, while in others, atopic dermatitis is particularly severe. Overall, however, children are affected more often than adults. For some, it accompanies them throughout their lives, but symptoms often diminish during puberty. Nevertheless, the skin remains in need of care throughout life because it is dry and sensitive.

In atopic dermatitis, the stratum corneum lacks fats and moisturizing factors. This impairs its barrier function, and it cannot adequately protect the body from pathogens. The exact cause of this disease has not yet been conclusively determined. However, it is certain that there is a genetic predisposition. It is assumed that certain triggers – so-called provocation factors – lead to outbreaks. These can include hormonal fluctuations, stress, smoking, allergies, or even sweating.

Climate and season also play a role. The cold temperatures of winter combined with dry air from heating systems are just as unfavorable as heat and strong sunlight. Another problem is the use of improper cosmetics and cleaning products containing irritating ingredients. The triggers ultimately cause the outbreak depend on the individual.

Soothing for damaged skin

A healthy skin barrier is resilient and protects against irritation. Above the dermis is the stratum corneum. It gets its name from the stratum corneum cells that are bound together with lipids. Its function is not only to ward off external influences but also to prevent moisture loss. In atopic dermatitis, the stratum corneum is less robust because it lacks lipids and is only partially able to retain moisture. As a result, the skin is more permeable, allowing allergens to penetrate more easily. This increases the risk of irritation and inflammation.

Itching causes those affected to scratch the affected areas. This further aggravates the condition, causing further damage to the skin. Irritants and allergens consequently penetrate the compromised protective barrier even more easily. While up to 15 percent of young children suffer from atopic dermatitis, the number in adults is between two and four percent. However, adults often experience a more severe course.

There are also differences in the affected skin areas. In infants, atopic dermatitis occurs primarily on the cheeks and the outer sides of the legs and arms – less frequently on the abdomen, chest, and back. In later years, the neck, elbows, backs of the knees, palms, and soles of the feet become problematic areas. Less commonly, the face may also be affected. Regardless, treatment with creams or ointments is required. In addition to an itch-relieving effect, they also help by inhibiting inflammation.

Skin care for atopic dermatitis

Atopic dermatitis requires continuous skin care. Accordingly, it's important not only to react to symptoms as they occur, but also to take preventative measures. Most sufferers have to deal with dry skin their entire lives. Therefore, basic skin care, as dermatologists call it, is essential. The associated goal is to stabilize the skin barrier. This should make it possible to delay, mitigate, or even prevent flare-ups of the disease. Furthermore, even during symptom-free periods, it can be assumed that underlying inflammation of the skin often exists, and that the barrier as a whole is impaired.

When cleansing daily, it's important to remember that every wash dissolves oil and moisture from the skin. Water alone can do this. Certain soaps and other cleansers intensify this effect unless they are pH-neutral. Dermaplan Wash Balance is an ideal product, as it benefits users from its moisturizing properties. As with all of the brand's products, it contains no allergenic or harmful ingredients. Instead, it gently cleanses the skin. Tonic Sensitive is also gentle, a clarifying facial toner that is alcohol-free. Instead, panthenol, urea, and allantoin strengthen the damaged barrier and moisturize it.

Skin care for atopic dermatitis also includes regular moisturizing, ideally morning and evening. This ensures that the oil and moisture content remains as even and sufficient as possible. Ultimately, this strengthens the skin barrier and improves its condition in the long term. There are two simple but helpful rules: oil on dry skin and moist on moist. This means that products with a high oil content care for dry skin because they prevent moisture loss. However, if the skin is wet, creams with a higher water content should be used, as they have a cooling and drying effect.

It's also a good idea to adjust the oil content to the season. In the winter months, the protective covering is drier than in the summer and therefore needs more oil. Dermaplan offers the Lipid Balance series, which has a fat content of 15, 30, or 42 percent, depending on the product. Acute Itching Care can quickly bring the symptoms of atopic dermatitis under control. Long-term Itching Care, meanwhile, is used as a preventative measure.

Symptoms of atopic dermatitis

The symptoms of atopic dermatitis usually vary depending on the age of the affected person and can vary greatly in intensity. However, a characteristic of every age is that atopic dermatitis always occurs in phases, so that a symptom-free period is always followed by a period with sometimes extreme symptoms.

The most common symptoms are:

• Dry and reddened skin

• Scaly and sometimes weeping skin

• Usually severe itching

• Occurs in phases

• Scratching often causes eczema

• Tendency to allergic asthma

• Tendency to allergic rhinitis and allergic conjunctivitis

There are two types of atopic dermatitis: the intrinsic and the extrinsic types.

If a patient suffers from the intrinsic type of atopic dermatitis, this means that their blood levels for so-called IgE antibodies are normal. In this case, only mild atopic dermatitis usually develops, without additional respiratory allergies. This type of atopic dermatitis is more common and is often considered a precursor to the extrinsic type of atopic dermatitis.

In the extrinsic type of atopic dermatitis, blood levels show IgE antibodies. Therefore, in these cases, the likelihood of also developing asthma or hay fever is higher.

In babies, the course of atopic dermatitis usually begins on the face and scalp: this is where cradle cap forms. This is a yellowish-white, scaly crust on the reddened scalp. These skin changes may also ooze. At this age, atopic dermatitis is also usually seen on the extensor surfaces of the arms and legs, and sometimes a weeping eczema develops in the mouth area.

In children with atopic dermatitis, the skin's natural fatty layer is too thin and the skin barrier is impaired, significantly reducing the body's protection against external irritants. In addition, their impaired immune system reacts hypersensitively to stimuli. Skin redness and itching are the result.

As early as the first year of life, affected children develop flexural eczema, i.e., reddened, scaly, and crusted patches of skin in the creases of, for example, the backs of the knees, elbows, and/or wrists. The skin is simultaneously wet and dry, with little ability to retain moisture. Consequently, increased itching develops.

With age, these patches of skin thicken (lichenification) and become coarser. Furthermore, these areas of skin may be hyper- or hypopigmented—that is, they may be either too darkly or too strongly colored.

Symptoms of atopic dermatitis appear in approximately 60% of children within the first 12 months of life. By kindergarten age, atopic dermatitis has broken out and been diagnosed in approximately 90% of affected children. However, in the following years up to puberty, the disease progresses positively in most children, and symptoms decrease.

Possible causes and symptoms of atopic dermatitis

Unfortunately, the causes of atopic dermatitis are not fully understood. However, both genetic and specific trigger factors appear to play a role in the onset of the disease or its flare-ups.

Often, with increasing age, there is a spontaneous improvement in symptoms or (not infrequently) complete resolution of the disease. The skin changes can regress in half of patients by the age of 20. However, since the genetic predisposition persists, various factors can trigger a new flare-up at any time. 30-50% of all patients also develop another atopic disease, such as hay fever or asthma.

The most common provocation or trigger factors in atopic dermatitis include

Factors that can promote the outbreak of the disease or encourage a flare-up are called provocation or trigger factors.

• Sweat
• Climate – cold, humid, dry
• Hormones (e.g. during menstruation)
• Flower pollen
• Animal hair
• House dust mites (feces)
• Nicotine
• Preservatives, perfume
• Ozone, chlorine
• Stress, tension
• Textiles / skin contact with wool
• Drying of the skin due to too frequent bathing/washing (especially in small children)
• Various foods

In patients with atopic dermatitis, the skin barrier is disrupted. This causes extreme dryness, irritability, and water loss in the skin. This makes it easier for allergens to penetrate the skin and trigger a flare-up of atopic dermatitis. During a flare-up, the affected person's immune system overreacts to otherwise harmless stimuli, resulting in an inflammatory reaction accompanied by severe itching.

"In recent decades, the incidence of atopic dermatitis has increased significantly in the Western world."

For example, in childhood, dry skin is more likely to occur due to frequent bathing and washing, and in approximately 15-20% of patients, inhalation allergies to pollen, pet hair, and house dust mites occur, but allergic reactions to foods, for example, are less common. In adulthood, however, these allergic reactions are rarely triggered. Instead, emotional stress represents a major risk factor.

Avoiding these factors is essential to effectively manage atopic dermatitis. Therefore, it's crucial for each sufferer to identify the most important triggers for them, so they can then avoid them accordingly.

In patients with atopic dermatitis, the skin barrier is disrupted. This causes extreme dryness, irritability, and water loss in the skin. This makes it easier for allergens to penetrate the skin and trigger a flare-up of atopic dermatitis. During a flare-up, the affected person's immune system overreacts to otherwise harmless stimuli, resulting in an inflammatory reaction accompanied by severe itching.

But what is responsible for this? It's a question that's widely discussed among experts. The likely obvious answer is that a change in lifestyle is responsible for the increase in cases of atopic dermatitis. Hygiene standards are now much higher, and as a result, there's significantly less contact with various environmental substances. As a result, some people's immune systems react to what are otherwise harmless stimuli. Washing habits have also changed over the past few decades. This may compromise the skin barrier, causing the skin to react more sensitively.

Examinations and diagnosis of atopic dermatitis

If you suspect you or your child has atopic dermatitis, a visit to a doctor is essential. The doctor will determine the diagnosis and...

…if 3 of the following 4 main criteria apply:

• Severe itching
• Typically distributed eczema (age-appropriate)
• Chronic or recurring symptoms
• Pre-existing atopic disease (such as pollen allergy, asthma) in the child or a close relative

…and 1 of the following 4 secondary criteria is met:

• Elevated blood levels of IgE antibodies
• Positive allergy test (prick and intracutaneous test) for possible allergens
• White dermographism (after mechanical irritation of the skin, e.g. with a spatula or fingernail, the skin pales instead of reddening)

Since there are of course other skin diseases with similar symptoms, it is extremely important to be able to rule them out if neurodermatitis is suspected.

"For further and better diagnosis and to find the best possible treatment, it is advisable to consult a dermatologist and possibly also an allergist."

• Psoriasis or ringworm (hands/feet)
• Other eczemas (general contact dermatitis, irritant-toxic contact dermatitis, microbial dermatitis)
• In adults: Eczema stage of cutaneous T-cell lymphoma (a form of cancer of the lymphatic system)
• In infants: seborrheic dermatitis or other rare syndromes (e.g. metabolic disorder)
• Scabies (scabies)

For those suffering from atopic dermatitis, proper skin care is essential. Below we would like to give you some valuable tips, especially with regard to skin care.

The right skin care can help break the itch-scratch cycle and sustainably build and regenerate the skin's protective barrier.

Those affected should apply cream regularly, as consistent care helps improve the damaged skin barrier and protect the skin from external irritants. These can include viruses and bacteria, as well as sweat and detergent residues in clothing. Therefore, it's important to use appropriate creams even during symptom-free periods – because the predisposition remains, thus delaying a recurrence of atopic dermatitis.

It's important that the skincare products are as lipid-replenishing, moisturizing, and free of allergenic ingredients as possible. Depending on whether you're experiencing an acute flare-up or the season, oil-rich or water-based skincare products may be more effective. For basic daily care, creams or lotions with a higher water content are generally recommended. Dry and chapped skin, on the other hand, benefits more from a more oily skincare cream—it's best to apply this only to the affected area.

DERMAPLAN offers a complete range of products to provide comprehensive care for the troubled skin of people with atopic dermatitis. If you're experiencing itching, you should first use anti-itch care to relieve or even stop it. This will break the itch-scratch cycle and allow you to move on to supportive, long-term preventative skin care. To prevent severe atopic dermatitis flare-ups, consistent skin care is very important, even during symptom-free periods. The skin's protective barrier is sustainably regenerated and strengthened, making your skin better equipped to resist external irritants.

• Cleanse your face and body with the mild cleansing lotion every morning and evening. Gently pat your face dry—do not rub.
The Wash Balance is available in 200ml.

• After cleansing with the cleansing lotion, use the mild facial toner with nourishing ingredients that are alcohol-free. Facial toner removes any remaining residue from the skin, revitalizes, nourishes, and improves the texture of redness.
The Tonic Sensitive is available in 200ml.

• Apply the Acute Itching Cream to your itchy skin several times a day, or as needed. Continue using the Acute Itching Cream until you achieve the desired relief. This may take a few days.
The Itching Acute Care is available in 50ml.

• Cleanse your face and body with the mild cleansing lotion every morning and evening. Gently pat your face dry—do not rub.
The Wash Balance is available in 200ml.

• After cleansing with the cleansing lotion, use the mild facial toner with nourishing ingredients that are alcohol-free. Facial toner removes any remaining residue from the skin, revitalizes, nourishes, and improves the texture of redness.
The Tonic Sensitive is available in 200ml.

• Then apply a rich base cream to your face and body. Lipid Balance 3, with approximately 42% lipids, is particularly suitable as a night cream. Lipid Balance 2, with approximately 30% lipids, is sufficient as a day cream. If you prefer a less rich cream, Lipid Balance 1, with approximately 15% lipids, is suitable.
Lipid Balance 1 is available in 50ml and 150ml.
Lipid Balance 2 is available in 50ml and 150ml.
Lipid Balance 3 is available in 50ml and 150ml.

• If possible, shower/bathe only every other day.
• After showering/bathing, gently pat your skin dry – do not rub it dry.
• The water temperature should not exceed 32°C and the shower time should be less than 5 minutes.
• Do not bathe for longer than five to ten minutes. If possible, use water additives containing oil, as these have a moisturising effect.
• After showering/bathing, always apply a medical skin care product specifically for neurodermatitis, e.g. DERMAPLAN skin care.

When an acute flare-up occurs, moist compresses with black tea can also have a soothing and anti-inflammatory effect on the skin. In addition to the options of appropriate basic therapy and drug treatment for atopic dermatitis, other measures are available that can make life with this chronic skin condition easier.

Change your diet

In general, for atopic dermatitis patients, foods can trigger a reaction, but they don't always. While one food may worsen the skin in one sufferer, it may improve the skin condition in another. Therefore, a general statement regarding nutritional therapy is unfortunately not possible.

But there are some general rules: A balanced diet strengthens the body against infections that can trigger flare-ups. Alcohol and strong spices can be problematic because they increase blood flow to the skin, which in turn worsens the itching.

You should also use quickly absorbed sugars – such as those found in sweets and white flour products – sparingly, as they generally promote inflammatory processes in the body. Antioxidants (e.g., vitamins A, C, and E, carotenoids, the trace elements selenium and zinc, and various secondary plant substances) have an anti-inflammatory effect and are found in large quantities in the following foods: blueberries, tomatoes, corn, potatoes, carrots, onions, millet, nettles, broccoli, kale, and nuts.

Be sure to drink plenty of water – at least 2 liters a day. Water is important for the breakdown and removal of histamine. Avoid foods and drinks high in histamine, such as red wine, Emmental cheese, or salami. If possible, eat a healthy, light, and varied diet. Prioritize organic foods, dairy products, and meat and sausages from animals raised under humane conditions.

Would you like to exchange ideas with other affected people? Then take a look here:

www.neurodermitisportal.de/

The Neurodermatitis Portal is a non-profit self-help organization for people with neurodermatitis and allergies. It provides a forum where all affected individuals can discuss their issues free of charge. While this isn't a substitute for seeing a doctor, it can often be helpful simply to communicate with someone who has a similar experience.

This guide is intended to provide you with some general advice. However, it should not be used for self-diagnosis or self-treatment, as it is in no way a substitute for a visit to the doctor!

Of course, we would also like to be at your side with advice and support, so we are happy to answer your questions – including those about our products – by phone or email.

FAQ Atopic Dermatitis

Atopic dermatitis is one of the most common skin diseases. It occurs in phases – symptom-free periods alternate with more acute phases accompanied by redness, itching, and inflammation. This phenomenon has seen a sharp increase, particularly in the past three decades: the increase has been as much as 300 percent. Naturally, with such a complex topic, there are still unanswered questions in many areas. We address the most common ones here and provide the corresponding answers.