Atopic Dermatitis: a Review of Recent Advances in the Field

Joseph Lam; Sheila F. Friedlander

Disclosures

Pediatr Health. 2008;2(6):733-747. 

In This Article

Abstract and Epidemiology

Abstract

Atopic dermatitis is increasing in prevalence and currently affects 15-30% of children in urban areas. Immune dysregulation and an impaired epidermal barrier are important factors in the pathogenesis of this disease. Pruritus and a chronic relapsing remitting course are hallmarks of the disorder, and sleep disturbance can occur in both the patient and family. Preventive interventions include exclusive breastfeeding in the first 4 months of life and withholding solid foods for 6 months. The avoidance of irritants and the use of emollients decrease flares. Topical corticosteroids remain the mainstay of therapy, and should be judiciously utilized. Excessive and inappropriate use must be avoided, as well as 'steroid phobia'. The topical calcineurin inhibitors can be useful adjuncts. Systemic therapies are available for severe disease, but carry risks of adverse effects.

Epidemiology

Atopic dermatitis (AD), or childhood eczema, is a chronic skin disorder that often occurs in association with allergic rhinitis and asthma (known as the atopic triad). The prevalence of AD differs between countries/regions. In industrialized countries, the prevalence of AD has at least doubled in the last three decades,[1,2,3] and it affects approximately 15-30% of children.[4] Conversely, in developing countries it has been reported to be less than 10%.[5] The lifetime prevalence is estimated to be between 10 and 20%.[6]

In 45% of children, the onset of AD occurs during the first 6 months of life. It occurs during the first year of life in 60% of patients and before the age of 5 years in at least 85% of affected individuals.[7] In those children with onset before the age of 2 years, 20% will have persisting manifestations of the disease, and an additional 17% will have intermittent symptoms by the age of 7 years.[8]

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