Treatment of atopic dermatitis: updated recommendations (Part 1)

The Primary Care Dermatology Society − PCDC, UK, has revised clinical guidelines for the diagnosis and treatment of atopic dermatitis.

The development of modern technologies and research methods require continuous improvement of current treatment regimens for atopic dermatitis.

Find out in the article on estet-portal.com

leading recommendations in the diagnosis and treatment of atopic dermatitis.

Etiology of atopic dermatitis

Atopic dermatitis − an inflammatory skin disease that is histologically characterized by spongy changes with varying degrees of acanthosis and superficial perivascular lymphohistiocytic infiltrates.

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Clinical signs may include itching, flushing, scaling, and clusters of papulovesicles. The condition can be caused by the action of individual or a combination of the influence of external or internal factors. The terms "eczema" and "dermatitis" are considered synonyms.

Methods for preventing atopic dermatitis in children

The development of atopic dermatitis is influenced by both genetic and environmental factors. Typically, atopic dermatitis occurs in individuals with an “atopic predisposition,” which means that they may develop any or each of the three interrelated conditions & minus; atopic dermatitis, bronchial asthma and hay fever (allergic rhinitis). Often, such diseases are detected in individuals with a burdened family history.

Recent evidence suggests that filaggrin gene mutations may be the basis for the development of atopic eczema in up to half of patients with the condition. Filaggrin expression is critical in the conversion of keratinocytes into protein-lipid squamous particles that form the stratum corneum of the epidermis. Thus, the basis for the development of eczema is the primary defect in the barrier function of the skin, and immunological changes are likely secondary to increased penetration of the antigen through the damaged epidermal barrier.

The relevance of this finding is to confirm the importance of the regular use of emollients in the treatment of atopic dermatitis.

Factors to be minimized in the treatment of atopic dermatitis

Spontaneous manifestation of the manifestations of the disease may be the result of the influence of certain triggers, among which:

1.    application of soap and detergents;

2.    overheating combined with coarse clothing;

3.    skin infections;

4.    animal hair & saliva − symptoms that usually disappear when the person spends time in a different environment for a few days;

5.    aeroallergens (pollen) − reactions to airborne allergens can cause symptoms to worsen in early spring or summer in sensitized individuals and are most commonly seen in older children and adults;

6.    food − more common in newborns and young children;

7.    house dust mites − sensitized patients report worsening symptoms of facial eczema after sleep;

Discoveries in the pathogenesis of atopic dermatitis

Although atopic dermatitis is most often seen for the first time in children, onset can occur at any age. In particular, 1/3 of new cases of atopic dermatitis are registered in adults. It has been established that about 65% of children with preliminary manifestations of atopic dermatitis observe their regression at the age of 7 years, and 74% of children − until they reach the age of 16.

At the same time, it is impossible to accurately predict the reverse development of the pathological process, which must be remembered when drawing up a treatment regimen for atopic dermatitis. But it is known that the probability of the disappearance of the manifestations of the disease as the child grows older is the less, the more serious the primary symptoms of the pathological process.

Approaches to the diagnosis and treatment of atopic dermatitis

The clinical manifestations of eczematous lesions are varied, which is associated with the addition or absence of infectious factors, the age of the patient, ethnic origin, and the type of treatment for atopic dermatitis. These changes include: the localization of the lesions changes with age, the localization of the atopic process with lesions of the skin of the face is typical for children, the involvement of the flexor articular surfaces is typical, in some patients the lesions spread over time, which is important to consider in the treatment of atopic dermatitis.

Specific immunotherapy makes it possible to forget about atopic dermatitis

The main approaches in the treatment of atopic dermatitis:

1)    The complex use of skin emollients involves the rational use of moisturizers and soap substitutes.

2)    GCS-based creams or ointments should be applied in a thin layer to the affected areas of hyperemic skin.

3)    "Weekend steroid regimen" − for patients with frequent exacerbations of the process, steroid creams or ointments are prescribed for 2 days a week for exacerbation of the manifestations of eczema.

4)    Creams or ointments containing immunomodulators should be used on areas of thin skin (for example, on the face) in conditions of intensive use of creams based on steroid drugs.

A specialized examination by specialists is indicated in case of difficulties in the initial diagnosis of the patient's condition, severe course of the eczematous process, partial effectiveness of the treatment of atopic dermatitis, the development of steroid atrophy in the patient or uncertainty regarding the advisability of prescribing the amount of topical steroids or immunomodulators, as well as in the case of contact allergic dermatitis .

Filaggrin gene mutations as a cause of atopic dermatitis