- Clinical science
Atopic dermatitis (AD) is an inflammatory skin disease that typically manifests for the first time in early childhood. Although it often improves during adolescence, it may also become a chronic condition that extends into adulthood. Atopic dermatitis is often associated with other atopic diseases, such as asthma or allergic rhinitis. Although the underlying etiology is not completely understood, genetic components as well as exogenous and endogenous triggers are believed to play a role. The main symptoms of atopic dermatitis include severe pruritus and dry skin. Primary treatment involves managing the pruritus and moisturizing the skin. Topical steroids and calcineurin inhibitors may be added if treatment with moisturizers is insufficient. In severe cases, systemic therapy with steroids is required. The main complication of atopic dermatitis is the development of secondary infections.
- About 10–15% of all children are affected
- Onset of symptoms usually occurs between 3–6 months of age
- Disease often improves with age
Epidemiological data refers to the US, unless otherwise specified.
- Genetics (polygenic inheritance)
- Exposure to indoor dust
- Extremely dry or humid climate
- Emotional stress
- Skin irritation
- Further theories
- Main symptoms: intense pruritus and dry skin
- Infantile AD (age < 2 years)
- Childhood AD (age 2 to 12 years)
- Adult/adolescent AD (age > 12 years)
- Asthma and allergic rhinitis (see atopic triad)
- White dermographism: a physical finding of transiently blanched skin after skin stroking.
- Keratosis pilaris: Keratinized hair follicles ("rough bumps") typically distributed over extensor arms and thighs
The diagnosis of atopic dermatitis is usually based on patient history and clinical appearance. The American Academy of Dermatology suggests the use of several criteria that need to be fulfilled in order to establish the diagnosis, the most important of which are listed below:
- Essential features
- Important features
Assessing the severity
- ; : Lesions are usually dry in atopic dermatitis and more greasy in seborrheic dermatitis.
- Psoriasis; : onset is generally after adolescent years; lesions are typically covered with white or silvery scales and are commonly located on the extensor surface of extremetities
- Other eczematous diseases
- Infectious differentials
The differential diagnoses listed here are not exhaustive.
- Avoid triggers:
- Allergic trigger factors (pets, dust mites, pollen, certain foods)
- Irritants (clothing, chemicals)
- Keep the skin moist
- Breast feeding recommended during infancy
- Manage/eliminate stress
Management of AD based on disease severity
|Mild AD||Moderate AD||Severe AD|