Atopic Dermatitis: a Short Summary

• 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 are in clinical trials at the time of writing of this article (for example: dupilumab (anti-Il4))
• Others:
  • Phototherapy (UVA)
  • Psychotherapy

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

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