Section : Notes de congrès/conférences

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:

PATHOGENESIS

  • 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
    • haptens
    • filaggrin
    • antimicrobial peptides
    • neuropeptides…and the list goes on

RECOMMENDATIONS

  • General:
  • Medication:
    • 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.
    • topical:
      • first line:
        • topical steroids (watch out for skin atrophy…)
        • topical calcineurin inhibitors
      • others:
        • salt baths
        • anti-infectives
    • oral medication:
      • antihistamines
      • 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))
  • Others:
    • Phototherapy (UVA)
    • Psychotherapy

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

Source of information: Rubins A. Atopic Dermatitis: Pathogenesis, Therapy and Update. Dubai Derma Conference 2015