A4. Atopic dermatitis

• Affects 10% of children, but only 1 – 3% of adults
• Associated with other atopic diseases
  • Asthma
  • Allergic rhinitis
• Etiology
  • Polygenic inheritance
  • Environmental riggers
    • Dust
    • Heat
    • Infection
    • Skin irritation
• Pathophysiology
  • Epidermal skin barrier defect
    • -> water loss
    • -> allergens can penetrate barrier
  • Abnormal immune response
• Clinical features
  • Morphology
    • Acute
      • Erythematous maculopapular rash
      • Dry plaques
      • Oedema
    • Chronic
      • Lichenification
      • Scaling
      • Fissures
  • Mostly on flexor surfaces
    • Except in infants
  • Pruritus
  • Dry skin
  • Cheilitis
• Diagnosis
  • Clinical
  • Serum IgE elevated
  • Serum LDH elevated
• Complications
  • Staph infection
  • Eczema herpeticum
  • Tinea
• Treatment
  • Emollients
  • Topical corticosteroids
    • Mometasone
    • Clobetasol
  • Topical calcineurin inhibitors
    • Tacrolimus
  • Oral antihistamines
  • Oral immunosuppressive therapy
    • Corticosteroids
    • Cyclosporine
  • Biological treatment
    • Anti-IL-4 – dupilumab
    • Anti-IL-5 – mepolizumab
    • Anti-IL-31 – prevents itching
    • Anti-TSLP