Atopic Dermatitis: Diagnosis and Stepwise Treatment

Overview / Definition Atopic dermatitis (AD), also known as eczema, is a chronic inflammatory skin disorder characterized by pruritus, dryness, and eczema lesions. It is part of the atopic triad, which includes asthma and allergic rhinitis. Epidemiology AD is one of the most common skin diseases, affecting approximately 10-20% of children and 1-3% of adults worldwide. Its prevalence has been increasing in recent decades, particularly in urban areas. The condition often starts in early childhood, with a significant number of cases improving or resolving by adolescence. Pathophysiology / Mechanism The pathophysiology of AD is complex and involves a combination of genetic, environmental, and immunological factors. Key mechanisms include: Genetic predisposition: Mutations in the filaggrin gene lead to impaired skin barrier function. Immune dysregulation: An imbalance between Th2 and Th1 immune responses results in increased IgE production and eosinophilia. Environmental triggers: Factors such as allergens, irritants, and climate can exacerbate symptoms. Clinical Presentation AD presents with the following features: Itching: Often severe and can lead to sleep disturbances. Skin lesions: Erythematous, scaly plaques that may crust over, often located on the flexural areas, face, and neck in children. Chronicity: Lesions may become lichenified (thickened skin) due to chronic scratching. Diagnosis / Workup The diagnosis of AD is primarily clinical and based on history and physical examination. Key diagnostic criteria include: Pruritus: An essential feature for diagnosis. Typical morphology: Eczematous lesions in characteristic locations based on age. Chronic or relapsing course: Symptoms often recur over time. There are no specific laboratory tests for AD, but skin biopsies may be performed to rule out other conditions if the diagnosis is unclear. Allergy testing may be indicated for suspected food allergies or environmental triggers. Treatment / Management Management of AD