From the Guidelines
Atopic dermatitis (eczema) is a chronic, pruritic inflammatory skin disease characterized by a relapsing course, often associated with a personal or family history of allergic rhinitis and asthma. According to the guidelines of care for the management of atopic dermatitis in adults with topical therapies published in the Journal of the American Academy of Dermatology in 2023 1, this condition is usually diagnosed clinically, but alternative causes of dermatitis should also be considered.
Key Characteristics
- Chronic inflammatory skin disease
- Pruritic (itchy) symptoms
- Relapsing course
- Often associated with allergic rhinitis and asthma
- Can occur in both children and adults
Diagnosis and Evaluation
The diagnosis of atopic dermatitis is typically made clinically, based on a comprehensive history taking and physical exam 1. However, other diagnostic tests such as biopsy or patch testing may be performed if warranted to rule out alternative or concomitant causes of dermatitis.
Clinical Considerations
It is essential to consider the patient's personal and family medical history, as well as their symptoms and physical exam findings, when diagnosing and managing atopic dermatitis 1. By understanding the characteristics and clinical presentation of this condition, healthcare providers can develop effective treatment plans to manage symptoms and improve patient outcomes.
From the Research
Definition and Characteristics of Atopic Dermatitis
- Atopic dermatitis (AD), also known as atopic eczema, is a chronic relapsing inflammatory dermatosis characterized by pruritus, xerosis, and a close association with IgE-mediated sensitization to aeroallergens and foods 2, 3.
- It is a chronic inflammatory skin disease presenting with recurrent eczematous lesions and intense pruritus, common in both children and adults, often beginning in infancy 4.
- The distribution of lesions varies by age, with infants tend to have lesions on the cheeks and scalp, and very young children typically have involvement over the extremities, cheeks, forehead, and neck 2, 3.
Clinical Presentation and Progression
- Acute lesions of AD begin as erythematous papules and serous exudates, with secondary lesions including excoriations and crusted erosions due to scratching 2, 3.
- Subacute lesions appear as erythematous scaling papules and plaques, and if the itch and rash progress uncontrolled, chronic lichenified AD develops, featuring accentuated skin markings with hyperpigmentation 2, 3.
- The disease is characterized by intense itch, disruption of the skin barrier, and upregulation of type 2-mediated immune responses 5.
Pathogenesis and Risk Factors
- AD is determined by a genetic predisposition characterized by an impaired skin barrier and a T-helper-2-predominant inflammation 4.
- Barrier dysfunction from filaggrin predisposes patients to AD, and skin superinfection, particularly with Staphylococcus aureus, is common 2, 3.
- More than 60% of children with AD are at risk to develop allergic rhinitis or asthma (the atopic march) 2, 3.
Treatment and Management
- Trigger avoidance, skin hydration, and topical steroids are the first steps for improvement, with topical calcineurin inhibitors (TCI) used mainly for maintenance therapy 2, 3, 4.
- Restoration of the skin barrier is the main approach for treating and preventing AD, and novel, targeted therapies are under clinical investigation 4.
- Management of AD focuses on avoiding triggers, improving skin hydration, managing exacerbating factors, and reducing inflammation through topical and systemic immunosuppressants 5.