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
- 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.