- 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.
- 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.
- The prevalence of atopic dermatitis appears to have increased two- to threefold in many developed and developing countries during the last 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.
- 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.
- Atopic dermatitis often presents in infants and young children. The clinical presentation differs somewhat depending on the age of the patient.
- Secondary bacterial skin infections are common in patients with atopic dermatitis and must be promptly treated.
- 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).
- 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.
- Topical corticosteroids are the drugs of first choice for atopic dermatitis.
- Topical calcineurin inhibitors (tacrolimus and pimecrolimus) are alternate treatment options for adults and children over the age of 2 years.
- This chronic illness has substantial socioeconomic impact. The cost may be magnified by undertreatment.
On completion of the chapter, the reader will be able to:
Discuss the etiology of atopic dermatitis, including genetic and immune changes.
Describe the pathophysiology of atopic dermatitis, including predisposing factors.
Discuss the clinical presentation of atopic dermatitis, including diagnostic considerations.
Describe treatment approaches for atopic dermatitis, including nonpharmacologic management strategies and appropriate skin care.
Compare and contrast pharmacologic treatment modalities for atopic dermatitis, including topical therapies, phototherapies, and the use of systemic agents.
Recommend an appropriate treatment plan for a patient with atopic dermatitis.
Discuss the socioeconomic impact for the overall management of atopic dermatitis.
Describe clinical controversies and areas of further research in the management of atopic dermatitis.
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. AD is the most common type of eczema (Table 79-1).1 It is a chronic skin disorder involving inflammation with pruritus as the hallmark symptom and presentation. This ...