Atopic Dermatitis is a chronic inflammatory condition of the skin which affects around 5% of the population.
It is more prevalent in children living in industrialized nations with 15-20% affected.
Initial presentation is under the age of four in 2/3 of cases.
Global pollution and allergen-rich environment are some of the factors which explain high prevalence.
Out of this review of clinical trials and scientific publications the following can be said:
Genetic findings: it is a multifactorial disease depending on gene-gene interactions as well as genes interacting with the environment
The balance of the-Th2 cells is disturb with a Th2 predominance.
Th2 predominance means:
- -presence/activity of cytokines Il-4, Il-5, Il-10 and Il-13
- -IgE-mediated tissue reactions
- -increased levels of eosinophils
Pathogenesis of AD also involves:
- -keratinocytes and skin appendages
- -environmental factors (infections…)
- -fibroblasts and dendritic cells
- -antimicrobial peptides
- -neuropeptides…and the list goes on
anti-allergy measures (Advice for managing atopic dermatitis)
use of emollients (Article on emollients)
diet change (not as a primary measure)
high-altitude climate (above 1500m)
Many options are available in the management of this chronic condition and patient age, severity of disease, clinical response, previous treatment results need to be taken into account.
- -topical steroids (watch out for skin atrophy…)
- -topical calcineurin inhibitors
- -salt baths
- -Cyclosporine A (for a short “disease-free holiday)
- -Azathioprine (inexpensive)
- -Systemic steroids in severe cases only
- -Biologics and (for example: dupilumab (anti-Il4) and tralokinumab)
- -Phototherapy (UVA)
Source of information: Rubins A. Atopic Dermatitis: Pathogenesis, Therapy and Update. Dubai Derma Conference 2015