Atopic dermatitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Atopic dermatitis is a chronic inflammatory skin disorder that occurs primarily in children, but also affects adults, usually with a personal or family history of atopy including asthma, and allergic rhinitis. Atopic dermatitis presents usually with intense pruritus and is often associated with elevated levels of immunoglobulin E (IgE).
Historical Perspective
The term Atopic dermatitis was first coined by Fred Wise and Marion Sulzberger, American dermatologists, in 1933 and the first widely used diagnostic criteria for atopic dermatitis was published by Jon Hanifin and Georg Rajka, in 1980.
Causes
Aopic dermatitis is the result of either skin barrier dysfunction or by immune dysregulation due to genetic defects. The most important genetic defect includes the mutations in the filaggrin gene (FLG).
Epidemiology and Demographics
It now affects 10-20% of children and 1-3% of adults in industrialized countries, and its prevalence there has more than doubled in the past thirty years.[1]
Atopic dermatitis incidence is highest during infancy and early childhood. Majority of atopic dermatitis patients has onset of an onset <5 years of age.The prevalence of atopic dermatitis is approximately 5,000-20,000 cases per 100,000 children worldwide. In 2003, the prevalence of atopic dermatitis was estimated to be 10,700 cases per 100,000 children in United States.
Diagnosis
Diagnostic Studies
Due to the variable morphology, distribution of skin lesions and intermittent clinical features, it is very challenging to define the diagnosis of atopic dermatitis. Atopic dermatitis is primarily diagnosed based on the clinical presentation. Currently, the most used criteria worldwide is published by United Kingdom working group and is based upon history, morphology and distribution of eczematous lesions, and clinical features of atopic dermatitis.
In patients with atopic dermatitis, to rule out other skin conditions, histology examination of a skin biopsy and other laboratory tests (eg, serum immunoglobulin E, potassium hydroxide preparation, patch testing, genetic testing) can be considered.
Treatment
Medical Therapy
The mainstay of treatment for atopic dermatitis depends upon the severity of the disease and is treated with a combination of conservative and medical therapy. The goals of treatment include elimination of aggravating factors, skin barrier function repair, maintaining skin hydration and pharmacologic treatment of skin inflammation. Pharmacologic medical therapies for atopic dermatitis can be classified according to the several severity scales( (i.e SCORAD index, the eczema area and severity index [EASI], and the patient-oriented eczema measure [POEM]).
Primary Prevention
Primary prevention applies to the patients with history of other atopic diseases and has not been diagnosed with atopic dermatits yet. Its primary goal is to reduce the risk of developing atopic dermatitis in the future. Approaches to reduce development of atopic dermatitis in children usually includes minimization of administration of antibiotics in infants and infections in infants.
References
- ↑ Saito, Hirohisa. Much Atopy about the Skin: Genome-Wide Molecular Analysis of Atopic Eczema. International Archives of Allergy and Immunology 2005;137:319-325.