Atopic dermatitis (AD), the most common form of eczema, is the most common inflammatory skin disease of man. It affects approximately 20% of children and 10% of adults. In comparison, psoriasis affects 2-3% of the US population. Everyone from newborns to senior citizens can suffer from AD. Infants commonly show the red rash on the face, neck, diaper area, trunk and extremities while on children and adults it generally appears on the face, lips, creases behind the elbows and knees, and hands. The rash is usually very uncomfortable and produces intense itching. Vigorous scratching can result in secondary bacterial infections. AD patients usually complain of intense itching even with minimal rash. Quality of life is impaired. For example, 53% of adults report that AD negatively affects their lives, 82% avoid social or sports activities, 55% report sleep disturbances, 43% experience anxiety or depression and 86% report daily itching.
Cause
The main problems with AD are an abnormal skin barrier and particular abnormalities of the skin immune system. The defective skin barrier causes increased water loss from the skin, leaving it dry with an abnormal texture. Abnormalities of the skin immune system produce various chemicals called interleukins which produce intense itching and further deterioration of the skin barrier. All modern day therapy is directed to improving these abnormalities of the skin barrier and dysregulation of interleukins.
Therapy
Fortunately, we have made great progress in understanding the biochemistry and immunology of AD. We now have many treatment options available. These include a wide range of creams and ointments, ultraviolet light therapy, oral antihistamines and a variety of systemic medications. Even the most resistant cases of AD can be brought into better control with these treatments. Of course, therapy must be tailored to the needs of the individual patient. Soaking in a tepid bath or shower water from 10-15 minutes followed by drying the skin with a towel and immediately applying the proper moisturizer is of great benefit. Use of gentle soaps or soap free cleansers is important. Newer moisturizers which contain ceramide, a natural skin lubricant are now available over the counter.
Biologics
A very exciting new therapy are the “biologics”. These are medications that are self injected by adult patients (they are now being tested in children). They correct the immune abnormalities of AD without decreasing the entire immune system. They are very safe and can produce dramatic improvement. New biologic drugs are being tested and I expect new ones to be available in the next few years. Perhaps some will be available in the form of creams. The future for AD therapy is very bright.
