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:

 

 

PATHOGENESIS

Genetic findings: it is a multifactorial disease depending on gene-gene interactions as well as genes interacting with the environment

 

 

Immunological findings:

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
  • -haptens
  • –filaggrin
  • -antimicrobial peptides
  • -neuropeptides…and the list goes on

 

 

RECOMMENDATIONS

 

 

General:

anti-allergy measures (Advice for managing atopic dermatitis)

use of emollients (Article on emollients)

diet change (not as a primary measure)

neurovegetative training

high-altitude climate (above 1500m)

patient education

 

 

Medication:

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:

first line:

  • -topical steroids (watch out for skin atrophy…)
  • -topical calcineurin inhibitors

 

 

others:

  • -salt baths
  • -anti-infectives

 

 

Oral medication:

  • -antihistamines
  • -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)

 

 

Others:

  • -Phototherapy (UVA)
  • -Psychotherapy

 

 

Source of information: Rubins A. Atopic Dermatitis: Pathogenesis, Therapy and Update. Dubai Derma Conference 2015