Abstract
Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease, associated with impaired skin barrier function and an atopic background. Various complicating factors, such as irritants, aeroallergens, food, microbial organisms, contact allergens, sweat, and scratching can induce the development of AD symptoms. Irritants, including soap/shampoo and clothes, can cause itching and eczematous lesions. In addition, young children with AD tend to become sensitized to eggs, milk, or peanuts, while older children and adults more often become sensitized to environmental allergens, such as house dust mites (HDM), animal dander, or pollen. Serum-specific IgE levels and skin prick test reactions to food tend to show high negative predictive values and low specificity and positive predictive values for diagnosing food allergy. On the other hand, AD adult patients tend to have severe skin symptoms and exhibit high HDM-specific IgE levels. Microbial organisms, e.g., Staphylococcus aureus and Malassezia furfur, might contribute to the pathogenetic mechanisms of AD. While sweat plays a major role in maintaining skin homeostasis, it can become an aggravating factor in patients with AD. Furthermore, scratching often exacerbates eczematous lesions. Several patient-specific complicating factors are seen in most cases. The identification and management of complicating factors are important for controlling AD.
Highlights
Atopic dermatitis (AD) is a common, chronic relapsing inflammatory, multifactorial skin disease, which is characterized by intense pruritus [1,2,3]
Even when a patient’s serum levels of house dust mites (HDM)-specific IgE are increased and strong reactions to HDM are seen during skin tests, whether exposure to HDM is considered to be an aggravating factor in that case should be determined based on the patient’s episodes and symptoms [1]
Ridolo et al reported that the treatment of AD with the causative aeroallergen can be used as an add-on therapy in selected patients who are non-responsive to conventional therapy [30]
Summary
Atopic dermatitis (AD) is a common, chronic relapsing inflammatory, multifactorial skin disease, which is characterized by intense pruritus [1,2,3]. The mechanisms responsible for the onset and aggravation of AD involve skin barrier dysfunction and an atopic background. In patients with AD, the functions of the intercellular lipids of the stratum corneum are impaired because of abnormal reductions in ceramide levels [5,6]. A loss-of-function mutation in filaggrin and filaggrin deficiency related to inflammation have been observed in patients with AD [7,8]. A reduction in skin barrier function might allow stimuli and allergens to penetrate the skin more . Several patient-specific complicating factors are seen in most cases. This review concisely discusses the identification and management of the complicating factors of AD
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