Update on Atopic Dermatitis

Abstract

With an increasing prevalence during the past decades, atopic dermatitis has become a global health issue. A literature search following a targeted approach was undertaken to perform this non-systematic review, which intends to provide an overview of the epidemiology, pathophysiology, clinical features, comorbidities, and current therapies for the treatment of atopic dermatitis. In sum, this is a heterogeneous skin disorder associated with variable morphology, distribution, and disease course. Although not completely understood, its pathogenesis is complex and seems to result from a combination of genetic and environmental factors that induce skin barrier dysfunction, cutaneous and systemic immune dysregulation, skin microbiota dysbiosis, and a strong genetic influence. Diagnosis is based on specific criteria that consider patient and family history and clinical manifestations. Overall disease severity must be determined by evaluating both objective signs and subjective symptoms. Therapeutic goals require a multistep approach, focusing on reducing pruritus and establishing disease control. Patients should be advised on basic skin care and avoidance of triggers. Topical anti-inflammatory agents should be considered in disease flares or chronic/recurrent lesions. In case of inadequate response, phototherapy, systemic immunosuppressants and, more recently, dupilumab, should be added. Nevertheless, the treatment of moderate-to-severe atopic dermatitis remains challenging and novel, efficacious, safe and targeted treatments are urgently needed. In conclusion, although the last few years have seen important improvement in the understanding of the disease, future research in atopic dermatitis will continue exploring gene-environment interactions and how it affects pathophysiology, disease severity, and treatment outcomes.

Atopic Dermatitis Host and Environment Model: Revisiting Therapeutic Options

“…Low-potency TCS are indicated for mild disease, flexural and facial skin lesions, young children and pregnant women. High potency TCS are preferred for older patients, lichenified and chronic prurigo-like lesions and palms (14). It has been shown that TCS have a greater absorption rate and systemic uptake in patients with clinically severe disease, when compared to patients with mild or moderate disease, suggesting caution in their use in more advanced stages of the disease and in infants (15).…”

SnapshotDx Quiz: December 2019

“…CORRECT ANSWER: c. Atopic dermatitis Atopic dermatitis (AD) is a chronic skin condition that has a relapsing and remitting course. The pathogenesis of AD is not entirely understood; it seems to result from a combination of genetic and environmental factors that induce skin barrier dysfunction, cutaneous and systemic immune dysregulation, skin microbiota variations, and a strong genetic influence (Torres et al, 2019). AD has a broad clinical spectrum and variants depending on age.…”

“…While pathology is not specific and varies with the stage of the lesions, it shows spongiosis, acanthosis with hyperkeratosis and parakeratosis (as seen in Figure 1). Patients with AD can also have other associated features such as asthma, allergic rhinitis, and seasonal allergies (Torres et al, 2019). Other associated skin findings include hyperlinear palms (as seen in Figure 1), keratosis pilaris, ichthyosis, Dennie-Morgan lines, xerosis, and "allergic shiners.…”

“…Contact allergy has a reported prevalence of up to 20% in atopic individuals (Teo et al, 2019). In a retrospective analysis performed in the United Kingdom to investigate the prevalence of contact allergies in atopic individuals compared with individuals without AD, the study showed 10 allergens with a higher prevalence in AD patients (Torres et al, 2019). The study examined patients who were referred for patch testing to the Department of Cutaneous Allergy at St. John's Institute of Dermatology.…”

Crocin ameliorated skin tissue inflammation in atopic dermatitis in mice

“…AD has become a universal health concern, especially in developed countries associated with impairment of the quality of life. 1 Considered the superior cause of non-fatal condition in the skin, AD is estimated to influence about 230 million worldwide according to WHO. 2 Therapeutic objectives focused mainly of attenuating pruritus as well as controlling the disease spread.…”