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