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SF | DERMATOLOGY
September 2021 | Vol. 21 No. 9 www.medicalacademic.co.za
Photo credit: Shutterstock.com
This article was independently sourced by Specialist Forum.
How to recognise ATOPIC ATOPIC dermatitis Atopic dermatitis (AD) is a common itchy skin condition that tends to run in families. Individuals with AD show a genetic predisposition to allergic conditions such as asthma, allergic rhinitis, allergic conjunctivitis, and food allergy. AD is a potentially debilitating disease and can lead to serious lifethreatening complications.1,2,3
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n our article on page 19 we discuss some of the life-threatening complications associated with AD, which include sepsis, endocarditis and bone and joint infections.
Prevalence of AD in South Africa Although AD predominantly presents in early childhood (see box 1 for diagnostic criteria), adult onset AD (late onset) is also common. Studies have also shown that the prevalence of AD differs significantly between ethnic groups. In the United States for example, AD prevalence was higher in children from African descent compared to Caucasians. 2 Numerous studies suggest that the prevalence of AD is increasing in South Africa. From 1995 to 2002, increases were reported for adolescents (13- to 14-years) in Cape Town for self-identified symptoms of AD (15.5%26.2%) and physician-diagnosed AD (9.6%-16.7%).3 AD is more common in urban than rural settings in South Africa. For example, in Cape Town, a prevalence of 23.5% was reported in children between one- to three-years, compared to 1.8% in the rural Eastern Cape.3
Impact on quality of life While many cases of AD are mild, and can be
managed with simple topical treatment, up to 50% of AD cases are moderate–severe, which negatively impact patients quality of life (QoL) as a result of constant itching, loss of sleep, pain, and social isolation due to low self-esteem.1 AD has been shown to be associated with psychiatric disorders (depression and anxiety) and suicidality as a result of constant itching and discomfort, disfigurement, and perceived social-stigmatisation. In addition, poor sleep related to AD may increase the risk of psychiatric disorders.4 Schonmann et al found that among the 526 808 patients with AD included in their study, AD was associated with increased incidence of new depression (14%) and anxiety (17%). They observed a stronger effect of AD on depression with increasing severity compared with no AD: mild (10%), moderate (19%) and severe (26%).4 In addition, they found that AD was more strongly associated with depression and anxiety in those aged 40 to 59 years (compared with younger and older age groups) and were more prevalent in men than in women.4
Presentation and diagnosis of AD The cardinal symptom of AD is itching, which can be debilitating. Clinical findings are characterised by ill-defined, papular erythema and fine scale. Chronic eczema results in thickening and increased scaling of the skin (lichenification).1 Generalised dry skin (xerosis and/ or ichthyosis vulgaris) is typical in more extensive cases. Depending on the severity and chronicity of disease, skin findings may also include exudate, vesicles, fissures, lichenification and excoriations.1