It is sometimes difficult to distinguish AD from other skin diseases (p.B. seborrheic dermatitis, contact dermatitis, psoriasis, scabies); However, a family history of atopy and the distribution of lesions are useful in many cases to make the diagnosis. Psoriasis, for example, usually affects the extensor muscle rather than the bending surfaces and often affects the nails, palms, and soles of the feet. Seborrheic dermatitis usually affects the diaper area and scalp in infants and the face in adults (for example. B, the sides of the nose, eyebrows, external auditory canal). In addition, unlike AD, a family history of atopic disease is less common in patients with seborrheic or contact dermatitis. Scabies is usually associated with the presence of pustules on the palms, soles of the feet, genitals and between the fingers. Other diseases that should be considered in the differential diagnosis of AD are nutritional deficiencies, malignant tumors, and keratinization or immunodeficiency disorders associated with skin manifestations (see Table 3) [9]. Eczematous lesions, intense itching and recurrent course of the disease, as well as associated atopic diseases in the personal or family history are the hallmarks of atopic dermatitis (AD), a common chronic inflammatory skin disease. AD affects about 20% of all children aged 6 and 5% of adults in Western industrialized countries [1, 2]. The development of AD is based on a genetic predisposition that determines both skin barrier function and the predominant inflammatory response of the T-helper-2 (Th2) type. In addition, environmental factors can trigger AD by further affecting the skin barrier and inflammation.
Th2 cytokines have been shown to further alter the epidermal barrier. Thus, irritants and allergens can enter the epidermis and perpetuate inflammation. In addition, in more than 80% of patients with disease, the skin is colonized by Staphylococcus aureus, which can further damage the barrier and stimulate the immune response, triggering and maintaining inflammation [3]. Simpson EL, Chalmers JR, Hanifin JM, Thomas KS, Cork MJ, McLean WH, Brown SJ, Chen Z, Chen Y, Williams HC. The softening improvement of the skin barrier from birth allows effective prevention of neurodermatitis. J Allergy Clin Immunol. 2014;134:818–23. Schmitt J, von Kobyletzki L, Svensson A, Apfelbacher C. Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors in atopic eczema: a systematic review and meta-analysis of randomised controlled trials. Fr J Dermatol.
2011;164(2):415–28. 36. Paller AS, Lebwohl M, Fleischer AB Jr., et al.; United States / Canada Study Group on Tacrolimus Ointment. Tacrolimus ointment is more effective than pimecrolimus cream with a similar safety profile in the treatment of atopic dermatitis: results of 3 randomized controlled studies. J am Acad Dermatol. 2005;52(5):810–822. 14. Sidbury R, Tom WL, Bergman JN, et al. Guidelines for the Treatment of Atopic Dermatitis: Section 4. Prevention of Disease Outbreaks and Use of Adjunctive Therapies and Approaches. J am Acad Dermatol.
2014;71(6):1218–1233. Egawa G, Kabashima K. Multifactorial skin barrier deficiency and atopic dermatitis: essential topics to prevent atopic walking. J Allergy Clin Immunol. 2016;138(2):350–8. Simpson EL, Bieber T, Guttman-Yassky E, Beck LA, Blauvelt A, Cork MJ, Silverberg JI, Deleuran M, Kataoka Y, Lacour JP, Kingo K, Worm M, Poulin Y, Wollenberg A, so Y, Graham NM, Pirozzi G, Akinlade B, Staudinger H, Mastey V, Eckert L, Gadkari A, Stahl N, Yancopoulos GD. Ardeleanu M; researchers SOLO 1 and SOLO 2. Two Phase 3 studies of dupilumab versus placebo in atopic dermatitis.
2016;375(24):2335–48. Tsakok T, Marrs T, Mohsin M, Baron S, du Toit G, Till S, Flohr C. Does atopic dermatitis cause a food allergy? A systematic overview. J Allergy Clin Immunol. 2016;137(4):1071–8. This article was published as part of Allergy, Asthma & Clinical Immunology Volume 14 Supplement 2, 2018: Practical guide for allergy and immunology in Canada 2018. The full content of the supplement is available online at aacijournal.biomedcentral.com/articles/supplements/volume-14-supplement-2. 38. Eichenfield LF, Ahluwalia J, Waldman A, et al. Current Guidelines for the Assessment and Treatment of Atopic Dermatitis: A Comparison of the Joint Working Group and American Academy of Dermatology Practice Parameters Guidelines.
J Allergy Clin Immunol. 2017;139(4S):S49 to S57. Kelleher M, Dunn-Galvin A, Hourihane JO, Murray D, Campbell LE, McLean WH, Irvine AD. Skin barrier dysfunction, measured by transepidermal water loss after 2 days and 2 months, is older than atopic dermatitis after 1 year and predicts it. J Allergy Clin Immunol. 2015;135(4):930–5. Bae JM, Choi YY, Park CO, Chung KY, Lee KH. Efficacy of allergen-specific immunotherapy in atopic dermatitis: a systematic review and meta-analysis of randomised controlled trials. J Allergy Clin Immunol. 2013;132(1):110–7.
45. Bass AM, Anderson KL, Feldman SR. Interventions to increase adherence in paediatric atopic dermatitis: a systematic review. J Clin Med. 2015;4(2):231-242. IgE sensitization is observed in 80% of AD patients; However, 20% do not have elevated serum IgE or positive skin test reactions [122]. Interestingly, significantly higher IgE levels have been found in male patients compared to females [22]. Signs of atopy and concomitant atopic diseases are significantly more common in patients with early and chronically persistent course [22]. Atopic dermatitis (AD) is a common chronic skin condition that can significantly affect the quality of life of people with Atopic disease and their families.
Although the pathogenesis of the disease is not fully understood, it appears to result from the complex interaction between defects in skin barrier function, environmental and infectious agents, and immune dysregulation. There are no diagnostic tests for AD; Therefore, the diagnosis is based on specific clinical criteria that take into account the medical history and clinical manifestations of the patient. Successful treatment of the disease requires a multifaceted approach that includes education, best practices in skin care, anti-inflammatory treatment with topical corticosteroids and/or topical calcineurin inhibitors, treatment of itching, and treatment of skin infections. .