PRIMEVIEW

ATOPIC DERMATITIS
For the Primer, visit doi:10.1038/s41572-018-0001-z

Atopic dermatitis (AD, also known as Environmental factors can trigger AD EPIDEMIOLOGY
PATHOPHYSIOLOGY in genetically susceptible individuals.
eczema) is a chronic inflammatory skin
disease. AD is characterized by recurrent Gene–gene and gene–environment Epidermal
effects regulate various underlying barrier Globally, ~230 million people are estimated
eczematous skin lesions (red patches with
blistering and crusting that can lead to Mutations RCVJQNQIKECN|OGEJCPKUOU dysfunction to have symptoms of AD (point prevalence).
in FLG, leads to increased AD can manifest at any point in life, but
scaling, cracking and thickening of the
encoding the permeability to allergens most often starts in early infancy. AD has a
skin) and intense itch and discomfort.
structural epidermal and pathogens relapsing-remitting disease course, and often
RTQVGKPȮNCIITKP and promotes persists into adulthood, leading to prevalence
can contribute to KPȯCOOCVKQP rates of ~20% in the paediatric population and
DIAGNOSIS epidermal barrier 10% in adults. The strongest known risk factor
dysfunction for AD is a family history of atopic diseases
The clinical phenotype of AD is highly
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variable and at least in part related to age, ethnicity
and disease severity. AD lesions can occur on any
area of skin in the body, although they typically
show an age-related distribution pattern: mostly QUALITY OF LIFE
on the face and trunk in infants, on flexor surfaces
(body folds) in children and on hands, Although AD is not a life-threatening disease, it
eyelids and flexor surfaces in can severely impair quality of life. On the basis
adolescents and adults. +PȯCOOCVKQP of quality of life measures, AD ranks second
can in turn to cerebral palsy among chronic childhood
CȭGEVUMKPKPVGITKV[ disorders. Itch is the most burdensome symptom
and stimulate the and can affect sleep quality, work or school
PREVENTION production of performance and social and emotional
CPVKIGPURGEKȮE well-being. Up to 30% of infants with
IgEs Cutaneous
sensory severe AD also have food allergy, and
Primary prevention approaches
nerves transmit up to 60% develop asthma and/or
to reduce the occurrence of
the itch signal to allergic rhinitis. Individuals with AD
AD have yielded mixed results. For
the brain, which are at increased risk of developing
example, elimination diets (that is, avoiding
leads to further mental health disorders (for example,
food allergens that could trigger AD flares)
scratching depression and anxiety) and other
could even be detrimental, as early exposure
inflammatory disorders, such as
of infants to peanuts, hen eggs and cow’s milk Dysbalance
inflammatory bowel disease.
seem to reduce the risk of allergic sensitization. of the commensal
Daily use of emollients in newborns who are at UMKPOKETQDKQVC
HQT
high risk of developing AD could be an effective MANAGEMENT example, Staphylococcus OUTLOOK
prevention strategy. aureus overgrowth)
Therapy aims to clear inflamed lesions, could be another The improved understanding of
reduce itch and establish lasting disease EQPVTKDWVKPI|HCEVQT AD pathogenesis has contributed
control to enable patients to be fully to the development of new
functional in their everyday lives. Topical effective drugs. Because AD is a
therapies with emollients and anti-inflammatory heterogeneous disease, the identification and
drugs are the mainstay for mild-to-moderate AD; characterization of disease subtypes will help
EMOLLIENT phototherapy and systemic immunomodulatory in the development of targeted prevention and
CREAM drugs can be effective in more-severe AD. OCPCIGOGPV|CRRTQCEJGU

Written by Lucia Brunello; designed by Laura Marshall Article citation ID: (2018) 4:2 ; doi:10.1038/s41572-018-0004-9; published online 21 June 2018
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