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AT-A-GLANCE

AT-A-GLANCE

  • Atopic dermatitis (AD) has a prevalence peak of 15% to 20% in early childhood in industrialized countries.

  • AD has variable rates of remission, with many patients continuing or recurring with symptoms into adulthood.

  • AD is a chronic or chronically relapsing disorder with major features of:

    • Pruritus

    • Eczematous dermatitis (acute, subacute, or chronic) with typical morphology and age-specific patterns

    • Facial and extensor involvement in infancy

    • Flexural eczema or lichenification in children and adults

    • Commonly associated with the following:

      • Personal or family history of atopy (allergic rhinitis, asthma, atopic dermatitis)

      • Xerosis or skin barrier dysfunction

      • Immunoglobulin E reactivity

  • Pathogenesis driven by skin barrier defects (most importantly in the FLG gene), environmental effects and alterations in immunologic responses in T cells, antigen processing, inflammatory cytokines, host defense proteins, allergen sensitivity, and infection.

INTRODUCTION

Atopic dermatitis (atopic eczema, AD) is a chronic inflammatory skin disease primarily beginning in childhood with a variable natural course. Itch is the hallmark symptom of the disease, often unrelenting in severe cases, and leads to sleep disturbance and excoriated, infection-prone skin. Patients with AD often additionally have atopic comorbidities such as allergic asthma and allergic rhinitis and experience a significantly impaired quality of life.

DEFINITIONS AND HISTORICAL PERSPECTIVE

NOMENCLATURE

The term atopic dermatitis was first coined in 1933 by Sulzberger and Wise and replaced early terms corresponding to probable AD such as tinea muquese, porrigo larvalis, and Hebra’s prurigo. The term atopy was first introduced by Coca and Cooke in 1923 to describe the tendency toward developing allergic hypersensitivity manifested by asthma and hayfever.1 The term atopi is derived from the Greek word atopos meaning “without place,” reflecting the mysterious pathogenic underpinnings of allergic hypersensitivity disease. Wise and Sulzberger coined the term atopic dermatitis in 1933 to describe recurring eczematous skin disease found in patients with a family history of atopic disease.2 Importantly, they noted that patients with AD may not have a personal history of other atopic disease. Since this seminal paper, several groups attempted to rename the disease primarily to differentiate AD that has concomitant immunoglobulin E (IgE) sensitization from AD without sensitization, such as atopiform dermatitis and nonatopic eczema. A recent systematic review reveals atopic dermatitis to be the most commonly used name for the disease and proposed the universal use of this term for AD.3 The authors of that paper discourage the use of less specific terms such as eczema, which is a morphological term and includes contact and other eczematous conditions.

DIAGNOSTIC CRITERIA

Significant advancement of our understanding of the disease could not be made without a proper disease definition. Early work by luminaries in AD, such as Rajka, Lobitz, and Hanifin, paved the way for the first comprehensive diagnostic criteria for AD—the Hanifin-Rajka criteria.4 The major criteria have been validated and remain ...

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