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  • Image not available.Atopic dermatitis is a chronic skin disorder involving inflammation associated with intense pruritus, a hallmark symptom. Management of atopic dermatitis must always include appropriate management of the associated pruritus.
  • Image not available. Atopic dermatitis is associated with other atopic diseases such as asthma and allergic rhinitis in the same patient or family. The three conditions are known as the atopic triad.
  • Image not available. The prevalence of atopic dermatitis appears to have increased two- to threefold in many developed and developing countries during the past three decades. Recent data indicate age and country or regional differences, with some countries showing no change or even a decrease. Rural areas appear to have lower prevalence rates.
  • Image not available. There are genetic and environmental factors in the pathogenesis and pathophysiologic manifestations of atopic dermatitis. The inheritance pattern is not straightforward. More than one gene may be involved in the disease, with the filaggrin gene (FLG) being a key player.
  • Image not available. Atopic dermatitis often presents in infants and young children. The clinical presentation differs somewhat depending on the age of the patient.
  • Image not available. Secondary bacterial skin infections are common in patients with atopic dermatitis and must be promptly treated.
  • Image not available. Management of atopic dermatitis must always include appropriate nonpharmacologic management of any controllable environmental factors, such as avoidance of identified triggers. These may include aeroallergens (e.g., mold, grass, pollen), foods (e.g., peanuts, eggs, tomatoes), chemicals (e.g., detergents, soaps), clothing material (e.g., wool, polyester), temperature (e.g., excessive heat), and humidity (e.g., low humidity).
  • Image not available. Nonpharmacologic management of atopic dermatitis entails managing the symptoms associated with pruritus and encouraging appropriate skin care habits such as proper bathing techniques and the copious use of moisturizers, which is a standard of care.
  • Image not available. Topical corticosteroids are the drugs of first choice for atopic dermatitis.
  • Image not available. Topical calcineurin inhibitors (tacrolimus and pimecrolimus) are alternate treatment options for adults and children over the age of 2 years.
  • Image not available. This chronic illness has substantial socioeconomic impact. The cost may be magnified by undertreatment.

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After reviewing this chapter the reader should be able to:

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  • 1. Discuss etiology of atopic dermatitis, including genetic and immune changes.
  • 2. Describe pathophysiology of atopic dermatitis, including predisposing factors.
  • 3. Discuss clinical presentation of atopic dermatitis, including diagnostic considerations.
  • 4. Describe treatment approaches for atopic dermatitis, including nonpharmacologic management strategies and appropriate skin care.
  • 5. Compare and contrast pharmacologic treatment modalities for atopic dermatitis, including topical therapies, phototherapies, and the use of systemic agents.
  • 6. Recommend an appropriate treatment plan for a patient with atopic dermatitis.
  • 7. Discuss the socioeconomic impact for the overall management of atopic dermatitis.
  • 8. Describe clinical controversies and areas of further research in the management of atopic dermatitis.

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Image not available.Atopic dermatitis (AD) is a common skin disease. It is often referred to as eczema, which is a general term for several types of skin inflammation. Atopic dermatitis is the most common type of eczema (Table 108–1).1 It is a chronic skin disorder involving inflammation with pruritus as ...

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