skin care in patients with atopic dermatitis

Atopic dermatitis is a common chronic skin disease with a relapsing course and associated with intense itching. It may occur at any age, most cases arising before the age of 5 years, though. The disease is based on an inherited genetic disposition, but its clinical manifestation is also triggered by factors such as aeroallergens, food allergens, cigarette smoke, sweat, irritants as well as stress and depression.

In Atopic dermatitis, barrier lipids in the lower part of the stratum corneum. are not formed normally. The absence of lipids results in impaired barrier function and increased water loss from the stratum corneum. As water is lost, the cells of the stratum corneum shrink and breaches open up between them. This leads to dry skin, which can neither retain water effectively nor prevent the entry of irritants or allergens. The use of soap on eczematous skin removes more lipids and reduces barrier function further. Individuals with eczema are more sensitive to the effects of soap and surfactants than others, and even their apparently normal skin has a lower threshold for irritation than that of non-sufferers.

Atopic dermatitis requires medical / dermatological treatment. Several topical (ointments, creams, lotions etc. with pharmaceutical ingredients) and systemic (pills, tablets) medications are available.
Appropriate skin cleansing and moisturising are helpful in preventing or attenuating eczematous flare-ups.

Skin cleansing
Moisturising, mild pH-neutral or acidic cleansers should be used. The use of bath oils free of fragrances and emulsifying agents is also recommended.
Soaps and bubble baths should be avoided. The water temperature should be moderately warm, not hot, and bathing or showering should not occur more often than once a day. Bathing time should not exceed 15 to 20 minutes. After the cleansing procedure, the skin should not be rubbed dry, but rather gently wiped dry with a soft towel. Immediately after showering or bathing, a moisturiser should be applied.

Hair wash
A mild, possibly fragrance-free shampoo should be chosen. As shampoos may lead to skin irritation and exacerbation of eczema, it is recommended to wash the hair over the skin or bath to avoid exposing eczematous areas of the body to shampoo. Wearing cotton-lined rubber gloves during the hairwash process helps in protecting the hands.

Skin care
Skin lesions in atopic dermatitis may vary from dry, thickened plaques to acute, exsudative (oozing) erythematous (reddened) eczema. The choice of emollients depends on the prevailing clinical picture and stage of eczema.

Skin care in acute dermatitis (with pronounced erythema (reddening), vesiculation or oozing)

• Lotions or creams based on light oil in water-emulsions should be preferred in acute lesions. Often, the treating dermatologist may include pharmaceutical ingredients such as antimicrobial agents to prevent infection.
  
• Fragrance-free products with a small number of ingredients minimise the risk of sensitisation (allergy development) to cosmetic products.
  
• Skin care products should be cooled, e.g. by storing them in the refrigerator. This enhances their itch-relieving effect.
  
• Emollients may be used several times a day, whenever the skin feels dry or itches. A whole-body application should occur at least once daily.

• Skin care products based on water in oil-emulsions (mixtures with more oil/ lipids than water) are recommended, as they have the following advantages:
  1) their fat/ lipid replenishing effect is greater than that of oil in water-emulsions (mixtures with more water than oil/ lipids)
  2) their hydrating effect on the stratum corneum is better than that of oil in water-emulsions (mixtures with more water than oil/ lipids)
  
• The use of water-free ointments or lipid-enriched water in oil-emulsions should be restricted to very dry skin areas, though, as these skin care products lead to an occlusion and sweat retention with subsequent itching. Thickened and lichenified dry skin areas respond best to ointments and lipid-enriched water in oil-emulsions.
  
• Water in oil-emulsions (mixtures with more oil/ lipids than water) with humectants (water-binding ingredients) such as urea, glycerin or lactic acid are strongly recommended, as they have an even greater hydrating effect on the stratum corneum. If there are erosions, fissures or cracks present, urea-containing emollients should be used with caution, as urea may cause burning or stinging when applied on fissured skin.
  
• Fragrance-free products devoid of preserving agents with a small number of ingredients minimise the risk of sensitisation (allergy development) to cosmetic products.
  
• Skin care products should be cooled, e.g. by storing them in the refrigerator. This enhances their itch-relieving effect.
  
• Emollients may be used several times a day, whenever the skin feels dry or itches. A whole-body application should occur at least once daily