Expired CME Article
Atopic Dermatitis
Abstract
Atopic dermatitis is a common, chronic skin condition characterized by xerosis, pruritus, and inflammation. Numerous factors place individuals at increased risk for developing this disease. T-helper cells and their cytokines, in addition to immunoglobulin E and eosinophils, play a major role in the pathogenesis of atopic dermatitis. Various hypotheses including the “hygiene hypothesis” and the “keratinocyte apoptosis hypothesis” have been proposed. Diagnosis is based on clinical criteria rather than objective testing. Allergic reactions to several triggers including foods may exacerbate symptoms. Treatment for atopic dermatitis consists of avoidance of triggers and administration of emollients, steroids, and topical immune response modifiers such as tacrolimus. Further research is necessary to better understand this disease.This content is limited to qualifying members.
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References
1. Engler RJ, Kenner J, Leung DY. Smallpox vaccination: Risk considerations for patients with atopic dermatitis. J Allergy Clin Immunol 2002; 110: 357–365.
2. Correale CE, Walker C, Murphy L, et al. Atopic dermatitis: A review of diagnosis and treatment. Am Fam Physician 1999; 60: 1191–1198, 1209–1210.
3. Fitzpatrick TB, Johnson RA, Wolff K, et al. Atopic dermatitis, in Color Atlas and Synopsis of Clinical Dermatology: Common & Serious Diseases. New York, McGraw-Hill, 2001, ed 4, pp 30–35.
4. Shaw JC. Atopic dermatitis. UpToDate 2002;10:1–10. Available at:http://www.uptodate.com/physicians/rheumatology_toclist.asp#Allergy. Accessed September 17, 2003.
5. Williams HC. Epidemiology of atopic dermatitis. Clin Exp Dermatol 2000; 25: 522–529.
6. Larsen FS, Hanifin JM. Epidemiology of atopic dermatitis. Immunol Allergy Clin North Am 2002; 22: 1–25.
7. Akdis M, Trautmann A, Klunker S, et al. T cells and effector functions in atopic dermatitis. ACI Int 2002; 14: 61–64.
8. Fujisawa T, Fujisawa R, Kato Y, et al. Presence of high contents of thymus and activation-regulated chemokine in platelets and elevated plasma levels of thymus and activation-regulated chemokine and macrophage-derived chemokine in patients with atopic dermatitis. J Allergy Clin Immunol 2002; 110: 139–146.
9. Wollenberg A, Kraft S, Oppel T, et al. Atopic dermatitis: Pathogenetic mechanisms. Clin Exp Dermatol 2000; 25: 530–534.
10. Reich K, Hugo S, Middel P, et al. Evidence for a role of Langerhans cell-derived IL-16 in atopic dermatitis. J Allergy Clin Immunol 2002; 109: 681–687.
11. Iwasaki M, Nagata K, Takano S, et al. Association of a new-type prostaglandin D2 receptor CRTH2 with circulating T helper 2 cells in patients with atopic dermatitis. J Invest Dermatol 2002; 119: 609–616.
12. Mascia F, Mariani V, Giannetti A, et al. House dust mite allergen exerts no direct proinflammatory effects on human keratinocytes. J Allergy Clin Immunol 2002; 109: 532–538.
13. Sicherer SH, Sampson HA. Atopic dermatitis: An update for the next millennium. J Allergy Clin Immunol 1999; 104.
14. Shah D, Hales J, Cooper D, et al. Recognition of pathogenically relevant house dust mite hypersensitivity in adults with atopic dermatitis: A new approach? J Allergy Clin Immunol 2002; 109: 1012–1018.
15. Thestrup-Pedersen K. Environmental factors and atopic dermatitis: How could they influence disease expression? ACI Int 2002; 14: 165–169.
16. Slavin R. Contact dermatitis, in Patterson R, Grammer LC, Greenberger PA (eds): Allergic Diseases: Diagnosis and Management. Philadelphia, Lippincott-Raven 1997, ed 5, pp 413–424.
17. Darsow U, Ring J. Atopic eczema, allergy, and atopy patch test. ACI Int 2002; 14: 170–173.
18. Fleischer AB Jr, Ling M, Eichenfield L, et al. Tacrolimus ointment for the treatment of atopic dermatitis is not associated with an increase in cutaneous infections. J Am Acad Dermatol 2002; 47: 562–570.
19. Reitamo S, Van Leent EJ, Ho V, et al; European/Canadian Tacrolimus Ointment Study Group. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone acetate ointment in children with atopic dermatitis. J Allergy Clin Immunol 2002; 109: 539–546.
20. Yanase DJ, David-Bajar K. The leukotriene antagonist montelukast as a therapeutic agent for atopic dermatitis. J Am Acad Dermatol 2001; 44: 89–93.
1. Engler RJ, Kenner J, Leung DY. Smallpox vaccination: Risk considerations for patients with atopic dermatitis. J Allergy Clin Immunol 2002; 110: 357–365.
2. Correale CE, Walker C, Murphy L, et al. Atopic dermatitis: A review of diagnosis and treatment. Am Fam Physician 1999; 60: 1191–1198, 1209–1210.
3. Fitzpatrick TB, Johnson RA, Wolff K, et al. Atopic dermatitis, in Color Atlas and Synopsis of Clinical Dermatology: Common & Serious Diseases. New York, McGraw-Hill, 2001, ed 4, pp 30–35.
4. Shaw JC. Atopic dermatitis. UpToDate 2002;10:1–10. Available at:http://www.uptodate.com/physicians/rheumatology_toclist.asp#Allergy. Accessed September 17, 2003.
5. Williams HC. Epidemiology of atopic dermatitis. Clin Exp Dermatol 2000; 25: 522–529.
6. Larsen FS, Hanifin JM. Epidemiology of atopic dermatitis. Immunol Allergy Clin North Am 2002; 22: 1–25.
7. Akdis M, Trautmann A, Klunker S, et al. T cells and effector functions in atopic dermatitis. ACI Int 2002; 14: 61–64.
8. Fujisawa T, Fujisawa R, Kato Y, et al. Presence of high contents of thymus and activation-regulated chemokine in platelets and elevated plasma levels of thymus and activation-regulated chemokine and macrophage-derived chemokine in patients with atopic dermatitis. J Allergy Clin Immunol 2002; 110: 139–146.
9. Wollenberg A, Kraft S, Oppel T, et al. Atopic dermatitis: Pathogenetic mechanisms. Clin Exp Dermatol 2000; 25: 530–534.
10. Reich K, Hugo S, Middel P, et al. Evidence for a role of Langerhans cell-derived IL-16 in atopic dermatitis. J Allergy Clin Immunol 2002; 109: 681–687.
11. Iwasaki M, Nagata K, Takano S, et al. Association of a new-type prostaglandin D2 receptor CRTH2 with circulating T helper 2 cells in patients with atopic dermatitis. J Invest Dermatol 2002; 119: 609–616.
12. Mascia F, Mariani V, Giannetti A, et al. House dust mite allergen exerts no direct proinflammatory effects on human keratinocytes. J Allergy Clin Immunol 2002; 109: 532–538.
13. Sicherer SH, Sampson HA. Atopic dermatitis: An update for the next millennium. J Allergy Clin Immunol 1999; 104.
14. Shah D, Hales J, Cooper D, et al. Recognition of pathogenically relevant house dust mite hypersensitivity in adults with atopic dermatitis: A new approach? J Allergy Clin Immunol 2002; 109: 1012–1018.
15. Thestrup-Pedersen K. Environmental factors and atopic dermatitis: How could they influence disease expression? ACI Int 2002; 14: 165–169.
16. Slavin R. Contact dermatitis, in Patterson R, Grammer LC, Greenberger PA (eds): Allergic Diseases: Diagnosis and Management. Philadelphia, Lippincott-Raven 1997, ed 5, pp 413–424.
17. Darsow U, Ring J. Atopic eczema, allergy, and atopy patch test. ACI Int 2002; 14: 170–173.
18. Fleischer AB Jr, Ling M, Eichenfield L, et al. Tacrolimus ointment for the treatment of atopic dermatitis is not associated with an increase in cutaneous infections. J Am Acad Dermatol 2002; 47: 562–570.
19. Reitamo S, Van Leent EJ, Ho V, et al; European/Canadian Tacrolimus Ointment Study Group. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone acetate ointment in children with atopic dermatitis. J Allergy Clin Immunol 2002; 109: 539–546.
20. Yanase DJ, David-Bajar K. The leukotriene antagonist montelukast as a therapeutic agent for atopic dermatitis. J Am Acad Dermatol 2001; 44: 89–93.
