Update on the Management of Atopic Dermatitis/Eczema

Abstract

Atopic dermatitis (AD) is a common chronic inflammatory skin disease that affects patients of all ages. The etiology is multifactorial, resulting from complex interactions of the immune system, environmental stimuli, and susceptibility genes. The prevalence of AD is increasing in industrialized nations, with as estimates as high as 20% of children and 3% of adults [1] . The financial and psychosocial cost of the disease is substantial [2] . Several studies have shown that AD in children is associated with a reduction in quality of life for patients as well as their families which is beyond that of other chronic diseases of childhood such as asthma, diabetes, and cystic fibrosis [3– 5] . The treatment of moderate to severe atopic dermatitis continues to be frustrating because of the lack of efficacy of most therapies and the chronicity of the disease. There are also potential side effects with most therapies – whether topical or systemic – and these risks must be weighed against the therapeutic benefit to the patient. Because the natural history of AD involves periods of waxing and waning severity, treatment plans are often dynamic and must change accordingly to reflect disease activity. Combination therapy is the rule, as the disease itself is the final manifestation of many contributing environmental and host factors. Commonly, trials of several different treatment modalities coupled with environmental measures are necessary before an effective, individualized regiman is achieved. The diagnostic criteria and pathophysiology of AD have been well described elsewhere [1, 7, 8] . This chapter will present the general approach to the patient with AD, including basic practice guidelines for all patients, as well as a review of many of the available topical and systemic agents. When possible, evidence