Atopic dermatitis: What is it and how to treat?
Atopic dermatitis is an inflammatory condition that presents with dry, itchy, inflamed skin (eczema) in the setting of generalized immune sensitivity. This is a systemic disease that affects not only the skin, but also may present with seasonal allergies and asthma or reactive airway disease. Immune system hypersensitivity (atopy) may also lead to numerous food allergies, contact skin allergies, and medication allergies.
Who gets atopic dermatitis?
Atopic dermatitis affects 10-20% of American school-aged kids. Onset of most atopic dermatitis is between the ages of 2 months to 2 years ( infantile). Chronic disease can persist into childhood and adulthood. Many children's skin disease improve in the first seven years of life and requires little management. The frequency of atopic dermatitis ahs exploded over the last thiry years. The origin of atopic dermatitis is unclear but there is usually a family component of atopy ( immune hypersensitivity manifesting as asthma, eczema, or allergic rhinitis/seasonal allergies) is unknown. Certain genetic mutations, epsecially fillagrin gene, has been identified to be associted with atopic dermatitis. There is no cure for atopic dermatitis.
Do I have atopic dermatitis?
Chronic skin rashes with intense itch and dry skin are good indicators of this disease. A good clinical history and physical exam can help a trained physician confirm the diagnosis in children and adults. Unclear presentations may require skin biopsies to confirm eczema skin changes. Skin cultures for secondary viral or bacterial infections may be necessary since the comprised skin in atopic dermatitis is prone to infections that prevents healing.
Individuals with atopic dermatitis may have other associated skin conditions such as keratosis pilaris (dry, hair follicle bumps on the arms and legs), dermatographism (hives from skin stroking or pressure), and ichthyosis vulgaris (generalized, severely dry skin presenting as scales refractory to moisturiaztion).
How do we treat atopic dermatitis?
Management of atopic dermatitis involves good skin care and therapies targeting skin inflammation and treatment of infection. Topical steroids and calcineurin inhibitors in addition to good skin hydration are essential. Severe conditions may require systemic medications or even injectable steroids. Narrow-band UVB light therapy is an effective, non-invasive treatment for atopic dermatitis.
What is new for atopic dermatitis?
The FDA recently approved Eucrisa ( crisaborole 2% ointment) for mild to moderate atopic dermatitis. This ointment is applied to affected areas twice a day. This may revolutionize the treatment of atopic dermatitis since this treatment is steroid-free and eliminates steroid-related long-term side effects to the skin.
Dupilumab is an injectable medication that is soon to be available for severe atopic dermatitis. This therapy is much anticipated and will be the first biologic treatment of its kind for this condition.
Contact your dermatologist or skin care provider for more information regarding any concerning skin diseases and to obtain correct diagnosis and management.
Arndt K, et al. Manual of Dermatologic Therapeutics, 8th Edition. Lippincott Wiliams & Wilkins 2014.