atopic dermatitis

Last edited 10/2020 and last reviewed 06/2023

This disorder occurs in 'atopic' individuals, i.e. those individuals who have a capacity to hyper-react to common environmental factors. Skin prick tests for various allergens are often positive but these results are of little value to clinical management because there is often a multifactorial aetiology.

• atopic eczema (atopic dermatitis) is a chronic inflammatory itchy skin condition that develops in early childhood in the majority of cases
• typically an episodic disease of exacerbation (flares, which may occur as frequently as two or three per month) and remissions - however In some cases it may be continuous
• atopic eczema often has a genetic component that leads to the breakdown of the skin barrier
• many cases of atopic eczema clear or improve during childhood, whereas others persist into adulthood
• some children who have atopic eczema will go on to develop asthma and/or allergic rhinitis; this sequence of events is sometimes referred to as the 'atopic march' (1)
• eczema can develop on any area of skin - however different distribution patterns are often observed at different stages of life
• in children younger than two years of age, eczema typically arises on the face, trunk, and limbs including the extensor surfaces
• in older children and adults, involvement of the neck and flexural aspects of the limbs (on the inside of joints, such as behind the knees and in the elbow creases) is common, as is involvement of the hands
• severity and extent of eczema are extremely variable, ranging:
• from mild eczema, with localised, occasionally dry, mildly scaly patches;
• moderate eczema, with slightly more redness and swelling, with little or no oozing or crusting;
• severe, generalised involvement of the whole body, resulting in acute skin failure with widespread, red, oozing, secondarily infected lesions
  
  
• both objective signs of eczema and subjective symptoms, such as itch and sleeplessness, contribute to the assessment of clinical severity

The serum levels of IgE may be raised.

Click here for example images of atopic eczema

Reference:

• NICE (December 2007).Atopic eczema in children Management of atopic eczema in children from birth up to the age of 12 years.
• Sawangjit R et al. Systemic treatments for eczema: a network meta-analysis. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD013206. DOI:10.1002/14651858.CD013206.pub2