Atopic dermatitis: What is it?
Atopic dermatitis is the most common inflammatory skin condition worldwide. Approximately 230 million people worldwide have atopic dermatitis, with a lifetime prevalence of more than 15%. Atopic dermatitis usually begins in early childhood and affects up to 20% of children. In approximately 80% of affected children, it develops by the age of 6. However, it may also first appear later in life.
The causes of the condition are complex. Genetic predisposition is one factor: atopic dermatitis tends to occur in families with a history of atopic dermatitis, asthma, or hay fever, which are collectively associated with atopic syndrome. However, not all children in such families will necessarily develop atopic dermatitis. A deficiency in filaggrin, a protein responsible for the skin’s barrier function, is another cause of atopic dermatitis. When filaggrin levels are low, the skin becomes fragile, dry, and vulnerable to secondary infections. In addition, a wide range of environmental factors can worsen the course of atopic dermatitis. These include sensitization to pollen, household, food, infectious, and other allergens. It is known that 30% of children with atopic dermatitis also have a food allergy. Stress also has a significant impact on immune-regulatory processes in the skin, causing an imbalance in the autonomic nervous system and a subsequent increase in the production of mediators by various inflammatory cells, including eosinophils.
What are the clinical signs of atopic dermatitis?
- Dry skin
- Severe itching
- A rash in typical locations:
In younger children—the cheeks, elbows, and knees
In older children—the flexural surfaces of the upper and lower extremities.
Atopic dermatitis is a clinical diagnosis. Major and minor diagnostic criteria are therefore used, along with the SCORAD system for assessing disease severity.
Treatment includes:
- skin care;
- topical treatment;
- systemic treatment;
- allergen-specific immunotherapy (when indicated, including initiation of parenteral ASIT).
The most important steps are to keep the child’s skin moisturized and respond promptly to flare-ups. Emollients should be applied daily to moisturize the skin.
