Atopic Dermatitis Management

Definition and Epidemiology

Atopic dermatitis (AD) is a chronic inflammatory skin condition that follows a relapsing course, occurring most frequently in children but also affecting adults, with approximately 60% developing symptoms in the first year of life and 90% by 5 years of age, according to the American Academy of Dermatology 1, 3
The prevalence of AD has increased dramatically in recent decades, affecting 10-20% of children and 2-3% of adults worldwide, as reported by the American Academy of Dermatology and the Journal of Microbiology, Immunology and Infection 2, 4

AD results from complex interactions between genetic factors, environmental exposures, skin barrier dysfunction, and immunological derangement, involving the "outside-in" and "inside-out" theories, as described in the Journal of Microbiology, Immunology and Infection 2, 5
Skin barrier abnormalities, including increased transepidermal water loss, are a key feature of AD, as noted in the Journal of Allergy and Clinical Immunology 6

The diagnosis of AD is made clinically based on historical features, morphology and distribution of skin lesions, and associated clinical signs, such as intense pruritus and eczematous lesions, as outlined by the American Academy of Dermatology 1, 3
Key clinical features include age-specific distribution patterns, chronic or relapsing disease course, and personal or family history of atopy, as described in the Journal of Microbiology, Immunology and Infection 2, 5

The American Academy of Dermatology recommends regular use of emollients/moisturizers as essential for all patients with AD, regardless of disease severity, to promote skin hydration and barrier repair 5
Topical corticosteroids (TCS) are the first-line therapy for acute flares, applied once or twice daily until significant improvement, with potency selection based on patient age, body location, and disease severity, as recommended by the Journal of Microbiology, Immunology and Infection 5
Phototherapy, including narrowband UVB, broadband UVB, and UVA1, is recommended for both acute and chronic AD after failure of topical therapies, as noted in the Journal of the American Academy of Dermatology 7, 9

A proactive therapy approach, including maintenance treatment with intermittent anti-inflammatory therapy (TCS or TCI) and regular use of moisturizers, can help prevent flares and improve long-term outcomes, as recommended by the American Academy of Dermatology 8, 5
Early intervention, including early and aggressive treatment of flares, can help prevent chronicity and improve quality of life, as noted in the Journal of the American Academy of Dermatology 8