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      Atopic Dermatitis: Natural History, Diagnosis, and Treatment

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      Publication date (Electronic):
      Journal: ISRN Allergy
      Publisher: Hindawi Publishing Corporation

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          Abstract

          Atopic dermatitis is an inflammatory skin disease with early onset and with a lifetime prevalence of approximately 20%. The aetiology of atopic dermatitis is unknown, but the recent discovery of filaggrin mutations holds promise that the progression of atopic dermatitis to asthma in later childhood may be halted. Atopic dermatitis is not always easily manageable and every physician should be familiar with the fundamental aspects of treatment. This paper gives an overview of the natural history, clinical features, and treatment of atopic dermatitis.

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          Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis.

          Colin N A Palmer, Alan D. Irvine, Ana Terron-Kwiatkowski … (2006)
          Atopic disease, including atopic dermatitis (eczema), allergy and asthma, has increased in frequency in recent decades and now affects approximately 20% of the population in the developed world. Twin and family studies have shown that predisposition to atopic disease is highly heritable. Although most genetic studies have focused on immunological mechanisms, a primary epithelial barrier defect has been anticipated. Filaggrin is a key protein that facilitates terminal differentiation of the epidermis and formation of the skin barrier. Here we show that two independent loss-of-function genetic variants (R510X and 2282del4) in the gene encoding filaggrin (FLG) are very strong predisposing factors for atopic dermatitis. These variants are carried by approximately 9% of people of European origin. These variants also show highly significant association with asthma occurring in the context of atopic dermatitis. This work establishes a key role for impaired skin barrier function in the development of atopic disease.
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            Filaggrin mutations associated with skin and allergic diseases.

            Alan D. Irvine, W McLean, Donald Y M Leung (2011)
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              Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis.

              A-M Calza, R Lever, DJ Atherton … (1993)
              Assessment methods for atopic dermatitis (AD) are not standardized, and therapeutic studies are difficult to interpret. To obtain a consensus on assessment methods in AD and to use a statistical method to develop a composite severity index. Consensus definitions were given for items used in the scoring system (extent, intensity, subjective) and illustrated for intensity items. Slides were reviewed to address within- and between-observer variability by a group of 10 trained clinicians, and data were statistically evaluated with a two-way analysis of variance. Two variants of an assessment system were compared in 88 patients at 5 different institutions. Data were analyzed using principal-component analysis. For 5 intensity items studied (erythema, edema/papulation, oozing/crusts, excoriations, lichenification), within- and between-observer variability was good overall, except for edema/papulation which was difficult to assess with slides. In the series of 88 patients, principal-component analysis allowed to extract two unrelated components: the first one accounting for 33% of total variance was interpreted as a 'severity' component; the second one, accounting for 18% of variance, was interpreted as a 'profile' component distinguishing patients with mostly erythema and subjective symptoms and those with mostly lichenification and dryness and lower subjective symptoms. Of the two evaluation systems used, the one using the rule of nine to assess extent was found more workable than the one using a distribution x intensity product. A scoring index (SCORAD) combining extent, severity and subjective symptoms was mathematically derived from the first system and showed a normal distribution of the population studied. The final choice for the evaluation system was mostly made based on simplicity and easy routine use in outpatient clinics. Based on mathematical appreciation of weights of the items used in the assessment of AD, extent and subjective symptoms account for around 20% each of the total score, intensity items representing 60%. The so-designed composite index SCORAD needs to be further tested in clinical trials.
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                Author and article information

                Journal
                Journal ID (nlm-ta): ISRN Allergy
                Journal ID (iso-abbrev): ISRN Allergy
                Journal ID (publisher-id): ISRN.ALLERGY
                Title: ISRN Allergy
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-5521
                ISSN (Electronic): 2090-553X
                Publication date Collection: 2014
                Publication date (Electronic): 2 April 2014
                Volume: 2014
                Electronic Location Identifier: 354250
                Affiliations
                Department of Dermatology, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
                Author notes

                Academic Editors: C. Pereira and Z. Zhu

                Article
                DOI: 10.1155/2014/354250
                PMC ID: 4004110
                PubMed ID: 25006501
                SO-VID: 2959eef2-0097-4633-b9ae-65516169d574
                Copyright © Copyright © 2014 Simon Francis Thomsen.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 February 2014
                Date accepted : 18 March 2014
                Categories
                Subject: Review Article

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