Atopic dermatitis (AD) is a very common, chronic inflammatory skin disease affecting up to 20% of children and 10% of adults in industrialized countries. Clinical features of AD include erythema, edema, lichenification, excoriations, oozing, and crusting. Pruritus is a crucial and dominant feature of AD and generates comorbidities such as sleep loss and psychological distress, creating a continuing disease burden for patients, parents and siblings.
The causes of AD remain unclear, but are likely to be multifactorial in nature, involving genetic, socioeconomic, and environmental factors. AD pathogenesis is not clearly elucidated, though skin barrier defects and altered immune responses are accepted as key components in disease development. Genetic and environmental factors strongly affect AD expression. Disease prevalence is increasing in developing countries, especially in urban regions. Resultant from these many factors, AD displays significant heterogeneity in disease phenotype, age of onset, clinical severity, persistence, comorbidities and response to therapy. Despite our improved understanding of the molecular pathways in AD, most traditional therapies are not based on scientific mechanistic understanding.
Some studies suggest that environmental factors influence the increase in the prevalence of AD. Small family size, increased income, education, migration from rural to urban environments, and increased use of antibiotics may all be associated with the rise in AD. Recent reports demonstrated that indoor air pollution, outdoor exposure to allergens, and environmental tobacco smoke are considered to be some of the environmental factors. However, the association between serum vitamin D levels or obesity and AD has still been controversial. The major medical co-morbidities associated with AD are infection; including Staphylococcus aureus superinfection and eczema herpeticum; however, chronic pruritus and sleep loss, as well as the time and expense associated with treatment, are often most distressing for patients and families.
The burden of atopic dermatitis on the quality of life (QOL) of patients and their families is substantial, encompassing physical and psychological well-being, social functioning, and economic costs. Atopic dermatitis associated with poor school performance, poor self-esteem, and family dysfunction.
The pathogenesis of AD is complex and multifactorial, characterized by genetic mutation, immune dysregulation, skin barrier dysfunction, and abnormal itch response. Impaired barrier function, which permits irritants to penetrate the skin surface and affects the local microbiome, is caused by the disease and may also contribute to the disease.
Identification of specific genes has provided evidence for a genetic basis. Evidence of link age was demonstrated for genes on chromosome 5q31-33, which encode cytokines involved in regulating IgE synthesis, namely interleukin (IL)-4, IL-5, IL-13, and granulocyte-macrophage colony-stimulating factor (GM-CSF).
To control AD, in addition to main pharmacologic therapy, other measures such as cutaneous hydration, identification and elimination of aggravating factors, relief of pruritus, and patient education should be considered. Atopic dermatitis is not curable, and many patients will experience a chronic course of the disease. Accordingly, the treatment of atopic dermatitis aims to (1) minimize the number of exacerbations of the disease, so-called flares, (2) reduce the duration and degree of the flare, if flare occurs. Prevention is best attained by trying to reduce the dryness of the skin, primarily via daily use of skin moisturizing creams or emollients along with avoidance of specific and unspecific irritants such as allergens and non-cotton clothing.
Traditional treatments for atopic dermatitis include the use of moisturizers to improve barrier integrity; topical anti-inflammatory medications when good skin care (such as bathing and moisturizing) is inadequate; and phototherapy, systemic immunosuppressant, or short course systemic corticosteroids for recalcitrant or severe disease.
Categorize the treatment options into 3: basic, standard medical, and adjuvant treatments. Reduction in dryness with emollient often relieves pruritus. Aggravating factors should be avoided by individualized evaluation.
Adjuvant therapy should be considered if AD symptoms are uncontrolled by adequate basic treatment.
Atopic dermatitis is associated with substantial economic burden for patients and their families, payers, and society. Direct costs can include prescriptions, over-the-counter treatments, physician and emergency department visits, and hospitalizations.