Atopic Dermatitis: a Short Summary
- Atopic Dermatitis is a chronic inflammatory condition of the skin which affects around 5% of the population.
- It is more prevalent in children living in industrialized nations with 15-20% affected.
- Initial presentation is under the age of four in 2/3 of cases.
- Global pollution and allergen-rich environment are some of the factors which explain high prevalence.
Out of this review of clinical trials and scientific publications the following can be said:
- Genetic findings: it is a multifactorial disease depending on gene-gene interactions as well as genes interacting with the environment
- Immunological findings:
- The balance of the-Th2 cells is disturb with a Th2 predominance.
- Th2 predominance means:
- presence/activity of cytokines Il-4, Il-5, Il-10 and Il-13
- IgE-mediated tissue reactions
- increased levels of eosinophils
- Pathogenesis of AD also involves:
- keratinocytes and skin appendages
- environmental factors (infections…)
- fibroblasts and dendritic cells
- antimicrobial peptides
- neuropeptides…and the list goes on
- Many options are available in the management of this chronic condition and patient age, severity of disease, clinical response, previous treatment results need to be taken into account.
- first line:
- topical steroids (watch out for skin atrophy…)
- topical calcineurin inhibitors
- salt baths
- first line:
- oral medication:
- Cyclosporine A (for a short « disease-free holiday)
- Azathioprine (inexpensive)
- Systemic steroids in severe cases only
- Biologics are in clinical trials at the time of writing of this article (for example: dupilumab (anti-Il4))
- Phototherapy (UVA)
Dr Christophe HSU – dermatologist. Geneva, Switzerland
Source of information: Rubins A. Atopic Dermatitis: Pathogenesis, Therapy and Update. Dubai Derma Conference 2015