Definition:

Atopic dermatitis/Eczema is an inflammatory response of the skin to multiple internal and external agents including genetic and environmental factors characterized by abnormalities in the epidermis and the immune system.

Etiology of Atopic Dermatitis/Eczema:

Patients with atopic dermatitis have an altered barrier of the skin, upper respiratory, and lower respiratory tract. Genetic changes present with loss of function mutations of filaggrin a protein present in the epidermis that is broken down into a moisturization factor. Filaggrin mutations are reported in 30%of dermatitis patients and can lead to ichthyosis vulgaris, allergic rhinitis, and keratosis pilaris. 90% of flares are caused by eggs, milk, peanuts, soy, and wheat. Atopic dermatitis is seen more at higher altitudes because of less sun exposure and low humidity levels.

Atopic dermatitis/Eczema is divided into three types based on the age of onset:

Early-onset atopic dermatitis (birth to 2 years old):  is the most common type of dermatitis, with approximately 60% of cases starting by age 1 and resolving by 12 years old.
Late-onset atopic dermatitis: symptoms start at 2-12 years of age.
Senile onset atopic dermatitis: an unusual pattern seen in patients older than 60 years old.

Pathophysiology:

Atopic dermatitis/Eczema patients have an increased susceptibility to cutaneous viral infections like warts and mullosca, severe herpes simplex and cutaneous fungal infection. The barrier defect may be caused by decreased levels of ceramides, which are sphingolipids in the stratum corneum and play a role in the skin’s barrier function. excessive itching causes keratinocytes to release inflammatory cytokines such as TNF-alpha, IL-1, and IL-6. Decreased anti-microbial peptides in the epidermis of atopic patients also contribute to Staphylococcus aureus colonization seen in more than 90% of patients.

In AD, there is significant dryness with no moisture content in the epidermis. The filaggrin element which is very important for epithelial integrity is missing.

History and Physical:

The pruritic lesions can lead to sleeplessness at night.
Family and/or personal history of the atopic triad
Presence of contact allergens
The triggers include allergens (e.g., dust mites, animal dander), sweating, soaps, fragrances, metals, clothing due to dyes and chemicals, food additives, and synthetic fabrics such as polyester.
Classic physical exam findings depend on age group.

 Infants: A dry scaly erythematous patchy dermatitis affecting the cheeks and chin is seen. This may later become generalized and affect the neck, chest, abdomen, back and extremities (usually extensor aspect) Infants have diaper dermatitis, such as candida or seborrheic dermatitis.

 Children: The lesions are less angry looking and flexural areas are involved i.e., cubital and popliteal fossae, neck, wrists, and ankles. Pruritis can be intense, and the itch-scratch cycle may set in, aggravated by dryness and perspiration. Some children have scattered, discrete, excoriated prurigo lesions.

Adults: Inflammation with lichenification may be localized or generalized. Lichenified and pigmented plaques of varying sizes and locations are usual manifestations.

Evaluation:

Atopic dermatitis/Eczema is diagnosed based on the distribution of lesions in different age groups and the presence of e.g., keratosis pilaris. A biopsy will show an eczematous pattern and tests for immunoglobulin E (IgE) antibodies against specific allergens.

Differential Diagnosis:

Allergic contact dermatitis
Lichen simplex
Lichen planus
Psoriasis
Scabies
Tinea
Seborrheic

Homoeopathic Treatment and management:

A full individualizing examination and case analysis is done along with a detailed medical history of the patient, physical and mental constitution, family history, present, predominant, persistent symptoms, pathology, causative factors etc. The correct homoeopathy remedy tries to correct this disease predisposition and the focus is not on curing the disease but to cure the person who is sick, to restore health.

Psychodynamics of Atopic Dermatitis/Eczema:

It usually takes 4 weeks for new cells to replace the old and the primary function of the skin is protection, regulation and sensation. whenever there is a conflict with our surrounding regarding separation, fear of being alone etc., the skin(epidermis) will be attacked.

If there is any kind of rejection, feeling ashamed, identity crisis, or feeling like an outcast where you are uncomfortable in your skin the consequent layers start getting affected.

Homoeopathy has a much deeper understanding of skin diseases and is a very promising cure in such conditions where even conventional treatment fails.

A case study of Atopic Dermatitis:

An 8-year-old girl came with severe itching on both forearms. Her mother said she is suffering from this for 5 years of age and has taken various treatments on and off. She is better for a while, but it gets worse every winter. She has to constantly apply moisturizer to prevent dryness. The girl sat with her mother in the consultation very quietly. she was a sweet-looking girl.

Doctor-Patient verbatim
Yes, tell me ”how are you?” with a very soft voice she said fine, but I get in trouble with this skin problem. Every winter I have to apply something as it continually itches and when I scratch, it increases with more intensity. I can’t concentrate on my studies, and I cry often looking at this dirty skin.
I always wear full sleeves dress to cover these eruptions as I don’t like it if someone criticizes or speaks rudely to me. But I don’t say anything.
My sister pokes fun at me, I try to remain calm but sometimes I just get angry and start talking loudly, but if my mom tells me to keep quiet I listen to her.

Analysis and evaluation:
She developed this eruption after her sister’s birth when her mother didn’t give much attention to her.
She was managing her complaints with medicines which gave her temporary relief but were troubles much because of their recurrence.
Also, she said it doesn’t look good so she tries to cover it with full sleeves dresses.
And most importantly though she was angry with people around her teasing especially her sister. she didn’t react much but occasionally.

Rubrics selected:
Mind;Jealousy children in
Ailments from embarrassment
Ailments from anger suppressed
Delusion Persecuted she is.

The remedy selected: Staphysagria 30 3doses stat.
Follow-up: Extraordinary results were seen in a span of 1 month, all eruptions were reduced and skin cleared up together.