Definition:

Atopic dermatitis, also known as atopic eczema, is the most prevalent inflammatory skin condition that is observed globally. It manifests as widespread dryness, itching, and a rash.

Epidemiology:

Approximately 230 million individuals worldwide suffer from atopic dermatitis, with a lifetime prevalence exceeding 15%, particularly in more affluent cultures. It usually impacts individuals who have a tendency for atopic conditions, which often tend to coincide with hay fever, asthma, and food allergies.

Typically, atopic dermatitis begins during infancy and can impact up to 20% of children. Around 80% of children who are affected experience the disease before they reach the age of 6. People of all age groups can be affected. 5–15% of young adults up to the age of 26 have it, despite the fact that it can settle in late childhood and adolescence.

Etiology:

Atopic dermatitis arises from a complex interaction of environmental and genetic aspects.

Atopic dermatitis (eczema) is a complex condition with multiple factors contributing to its development, making it difficult to identify a single cause. There are numerous theories concerning the underlying mechanisms. Ongoing research is exploring various factors, including the immune system, mutations in skin structural genes, abnormalities in skin cells (keratinocytes), and the presence of bacteria, viruses, and yeasts on the skin surface.

Clinical features:

The hallmark symptoms of AD at every stage include dry skin and pruritus. Subacute and chronic AD is characterized by dry, scaly, or excoriated papules or skin thickening (lichenification) from persistent scratching, but acute AD is characterized by erythematous papules and vesicles with exudation and crusting.

Clinical course and complications: AD progresses over months to years in a chronic, relapsing manner. Individuals who have mild disease may go through periods of intermittent flares followed by spontaneous remission. However, those with moderate to severe dermatitis typically do not experience complete clearance without receiving treatment.

Diagnosis:

The diagnosis of AD is clinical, which is established by evaluating the history, morphology, location of skin lesions, and related clinical symptoms. The diagnostic criteria include:

Pruritus
Eczematous dermatitis (acute, subacute, chronic) with characteristic morphology and age-specific patterns:

Facial, neck, and extensor involvement in neonates and young children

Flexural lesions in any age group, either present or past

Sparing the groin and axillary regions.

History of chronic or relapsing conditions

Management:

The primary objectives of managing atopic dermatitis (AD) are to alleviate symptoms (pruritus and dermatitis), avoid worsening of the condition, and minimize the potential risks associated with therapy.

Management includes the removal of aggravating factors, restoration of the skin barrier function and moisturization of the skin, patient education, and pharmacological intervention for skin inflammation.

Patient education is a crucial element of effective management. Patients are advised to:

– Regularly apply emollients to maintain skin hydration.

– Minimize aggravating elements such as: excessive bathing/washing without then moisturizing, exposure to cold, low-humidity conditions, excessive heat and perspiration, exposure to solvents, and strong detergents.

Patient with mild to moderate atopic dermatitis:

Topical therapies: Patients presenting with mild to moderate symptoms are treated with topical treatments.

The recommendation for the majority of patients with mild to moderate AD is to use topical corticosteroids and emollients instead of other topical anti-inflammatory medications.

Topical calcineurin inhibitors like pimecrolimus and tacrolimus are topical immunomodulators and work in a different way from corticosteroids, they are suitable for treating atopic dermatitis in sensitive sites such as the eyelids, skin folds, and genital area. It can be used interchangeably with topical corticosteroids.

Patients with moderate to severe atopic dermatitis:

Patients with chronic, moderate to severe disease that does not improve with the best available topical therapy need a systemic treatment. For the majority of these patients, administration of a biologic immunomodulatory agent (dupilumab, tralokinumab, or lebrikizumab) instead of traditional immunosuppressants, other immunomodulators, or phototherapy is recommended

Written by:

Mashael Alanazi, Medical Intern

Revised by:

Naif Alshehri, Medical Intern

Resources:

DermNet

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