From the Guidelines
Atopic dermatitis (Eczema) is a common, chronic, inflammatory skin condition characterized by intense pruritus, frequent associations with other allergic disorders, and significant impacts on quality of life.
Key Characteristics
- Affects up to 25% of children and 10% of adults 1
- Characterized by intense pruritus, which can be debilitating 1
- Frequently associated with other allergic disorders, such as asthma and hay fever 1
- Can lead to skin infections and neuropsychological issues 1
- Immunological skewing towards T helper 2 responses is a key feature of the disease 1
Clinical Presentation
- Nocturnal pruritus is a common symptom, which can severely affect sleep continuity and quality of life 1
- Sleep disturbance is experienced by 60% of children with AD, with 83% reporting sleep disturbance during exacerbations 1
- Circadian rhythms and diurnal variation in skin physiology may play a role in the nocturnal pattern of eczema flares 1
Diagnosis and Management
- A full skin examination should be carried out to record the extent and severity of eczema and to look for evidence of clinical infection 1
- Topical corticosteroids are the mainstay of treatment, but should be used safely and with precautions to avoid undertreatment or misuse 1
From the Research
Definition and Overview of Atopic Dermatitis
- Atopic dermatitis (AD), also known as atopic eczema, is a chronic relapsing inflammatory skin condition 2, 3, 4, 5, 6.
- It is characterized by intense itching and recurrent eczematous lesions 3, 6.
- The condition affects approximately 15% to 20% of children and 1% to 3% of adults worldwide 2.
Causes and Risk Factors
- Atopic dermatitis is caused by a complex interaction of immune dysregulation, epidermal gene mutations, and environmental factors that disrupt the epidermis 5.
- Defects in the epidermal barrier are central to the development of the condition 6.
- The condition is also linked to an increased risk of food allergy, asthma, allergic rhinitis, other immune-mediated inflammatory diseases, and mental health disorders 6.
Symptoms and Diagnosis
- The condition is characterized by intensely pruritic skin lesions and a self-perpetuating itch-scratch cycle 5.
- The American Academy of Dermatology has created simple diagnostic criteria based on symptoms and physical examination findings 5.
- A simplified version of the U.K. Working Party's Diagnostic Criteria can also be used to make the diagnosis 4.
Treatment and Management
- Maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers 5.
- Topical corticosteroids are the first-line treatment for atopic dermatitis flare-ups 4, 5.
- Pimecrolimus and tacrolimus are topical calcineurin inhibitors that can be used in conjunction with topical corticosteroids as first-line treatment 4, 5.
- Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 5.
- Newer medications, such as crisaborole and dupilumab, are effective in treating atopic dermatitis but are currently cost prohibitive for most patients 5.