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  Atopic eczema, irritant dermatitis and contact dermatitis


Atopic dermatitis (AD), or eczema, is a one of the most common forms of dermatitis that occurs. It is the fourth most costly skin disease in the United States. It affects people of all ages and is characterized by an ‘itch that rashes.’ It can also occur before five years of age and is more common among women. This section of the website discusses these details of atopic dermatitis and much more under the following headings:

What is atopic dermatitis?

The opening article gives an overview of atopic dermatitis. It defines the disease and its main features. Then there is a section on the clinical features of atopic dermatitis. This highlights the diagnostic and indicative features of the disease, including differential diagnosis (which is dealt with in more detail separately in another article). All this is important due to the lack of laboratory tests for the detection of the disease. The best way to detect and diagnose the disease is a proper knowledge of its clinical features. The diagnostic approach and clinical features are based on the age-wise occurrence of the disease – infantile, childhood and adulthood eczema.

Clinical features of atopic dermatitis

This dissertation touches upon the clinical response of the disease to therapy and its clinical disadvantages. Details of how to go about a differential diagnosis of atopic dermatitis is also included in this part of the website. It is very important to distinguish atopic dermatitis from other similar conditions, with the help of its clinical features based on its age-wise occurrence. Atopic dermatitis should not be confused with other conditions such as chronic dermatoses, infections and infestations, malignancies and metabolic, genetic and autoimmune malfunction.

Causes of atopic dermatitis

Next, there is a treatise on the causes of atopic dermatitis. The primary causes of atopic dermatitis are associated with heredity, environmental interactions, skin barrier disorders or immunological reactions. Each has a close link with our lifestyle and surroundings.

Genetics and epidemiology of atopic dermatitis

Since genetics has a major role to play in the development of atopic dermatitis, there is an article on this aspect, which is twinned with the epidemiology of the disease. Epidemiology traces out the cause the disease, its transmission within a population, its origin, spread and pattern of development.

Immunology and dysfunction in atopic dermatitis

Immunology and dysfunction in atopic dermatitis is another article in this section. Atopic dermatitis is associated with immunological reactions and neurologic and pharmacologic dysfunction. The study of immunology includes a discussion about immunopathology and cell-mediated immunoregulation associated with atopic dermatitis. This apart, there are details about the clinical conditions related to immunological reactions in atopic dermatitis, for instance the various allergic disorders and infections.

Role of microorganisms in atopic dermatitis

Since allergies are an integral part of atopic dermatitis, microorganisms have a major role to play in its development. In fact, the alarming rise of atopic dermatitis in the last few decades has been traced to the lack of exposure to microorganisms at an early age that in turn is linked to the breakdown of the family size, early use of antibiotics, greater hygiene and better living standards etc. This again has a close link with our immunological reactions to environmental conditions and lifestyles such as increasing pollution, diet patterns, air-conditioned homes etc.

Atopic dermatitis in pregnancy

Since atopic dermatitis affects more women than men, this article highlights its occurrence and management during pregnancy. It lays down certain precautions that a pregnant and a lactating mother must take to ensure the safe birth of the baby and to avoid medication related complications of eczema.

Treatment of atopic dermatitis

Treatment of atopic dermatitis has been extensively dealt with in this section of the website. It starts with the common treatment methods available and then goes on to discuss each of the major treatments in details under the subheadings:

  • Corticosteroids
  • Calcineurin inhibitors
  • Systemic therapy
  • Other new atopic dermatitis treatments

The primary therapeutic approach of atopic dermatitis is the use of corticosteroids. However, the use of corticosteroids in atopic dermatitis must be done with care and caution to minimize the side effects involved. The use of topical corticosteroids combined with moisturizer-based emollients is the standard procedure in atopic dermatitis prevention and treatment, for over 50 years. This hydrating combination increases the anti-inflammatory potential of the topical steroids and works to restore the skin barrier functions that get affected in atopic dermatitis.

A secondary option in the treatment of atopic dermatitis is the use of calcineurin inhibitors such as tacrolimus and pimecrolimus. Nowadays these topical calcineurin have become popular for treating atopic dermatitis, as they have anti-inflammatory functions and do not contain steroids. Hence, they help evade the side effects associated with the use of steroids.

In severe atopic dermatitis cases where other treatments fail, systemic therapies are often implemented. These include antihistamines, oral steroids, systemic immunomodulators, phototherapy and antimicrobials. However, most have side effects that need to be discussed.

The current trends in atopic dermatitis treatments have also been included in this section. The latest atopic dermatitis therapies are leukotriene antagonists, monoclonal antibodies such as infliximab, leflunomide, recombinant interferon gamma and intravenous immunoglobulin. Stress management and patient counselling is also a vital part of all kinds of therapy.