AAD Atopic Dermatitis Guidelines: Topical and Systemic

Overview / Definition Atopic Dermatitis (AD), also known as eczema, is a chronic inflammatory skin disease characterized by pruritic, erythematous, and scaly lesions. It often presents in early childhood and can persist into adulthood, significantly impacting the quality of life. Epidemiology Atopic dermatitis is one of the most common dermatologic conditions, affecting approximately 10-20% of children and 1-3% of adults worldwide. The prevalence has been increasing, possibly due to environmental factors, changes in diet, and microbial exposures. Pathophysiology / Mechanism Atopic dermatitis results from a combination of genetic, environmental, and immunological factors: Genetic predisposition: Mutations in the filaggrin gene lead to skin barrier dysfunction. Immune dysregulation: An imbalance between Th2 and Th1 cells results in increased IgE production and inflammation. Environmental triggers: Factors such as allergens, irritants, and microbial colonization can exacerbate the condition. Clinical Presentation AD typically presents with: Itchy skin: Often worse at night, leading to sleep disturbances. Erythematous patches: Commonly found on flexural areas, face, and neck in infants. Dry, scaly skin: Associated with xerosis and lichenification in chronic cases. Secondary infections: Staphylococcus aureus and herpes simplex virus are common pathogens. Diagnosis / Workup The diagnosis of atopic dermatitis is primarily clinical, based on the following criteria: Pruritus: An essential hallmark of the disease. Typical morphology: Erythematous papules, vesicles, and plaques. Chronicity: Symptoms persisting for weeks to months. Family history: A positive family history of atopy (asthma, allergic rhinitis). Additional tests may include: Skin biopsy: Rarely necessary but can rule out other conditions. Patch testing: To identify specific allergens in cases of suspected contact dermatitis. Treatment / Management The management of atopic dermatitis involves both non-pharmacologi