Atopic Dermatitis (AD)
AD is a chronic, relapsing inflammatory skin disease characterized by intense pruritus, eczematous lesions, and impaired skin barrier function. It often coexists with asthma, allergic rhinitis, and food allergies. Comprehensive care addresses barrier repair, inflammation, infection prevention, and quality of life.
Symptoms & Distribution
- Erythematous, scaly, oozing, or lichenified plaques
- Flexural areas (antecubital, popliteal), face, neck, hands; distribution varies with age
- Chronic itch leading to sleep disturbance, anxiety, depression
- Recurrent infections (Staph aureus, herpes simplex)
Pathophysiology
- Genetic predisposition (filaggrin mutations)
- Immune dysregulation (type 2 inflammation: IL-4, IL-13, IL-31, IL-22)
- Environmental triggers (irritants, allergens, stress, climate)
Diagnosis
- Clinical evaluation using criteria (Hanifin and Rajka, UK Working Party)
- Assess severity with SCORAD, EASI, POEM tools
- Allergy testing (IgE, patch testing) when indicated
- Rule out mimics (psoriasis, scabies, T-cell lymphoma)
Treatment Strategy
Skin Barrier Repair
- Daily lukewarm baths followed by liberal application of fragrance-free emollients
- Avoid harsh soaps, fragrances, wool
- Bleach baths or antiseptic washes for recurrent infections
Anti-Inflammatory Therapy
- Topical corticosteroids (class based on severity/site); use fingertip unit guidance
- Topical calcineurin inhibitors (tacrolimus, pimecrolimus) for face/folds
- Crisaborole (PDE4 inhibitor) for mild-moderate disease
- Wet wrap therapy for severe flares
Systemic/Advanced Therapies
- Phototherapy (narrowband UVB)
- Biologics: dupilumab, tralokinumab (IL-13), lebrikizumab (pending approvals)
- JAK inhibitors (upadacitinib, abrocitinib) for moderate-severe disease—monitor labs/infection risk
- Short courses of systemic steroids for severe flares (avoid chronic use)
- Immunosuppressants (cyclosporine, methotrexate, azathioprine) when newer agents unavailable
Itch & Infection Control
- Oral antihistamines (sedating) at night for sleep
- Treat bacterial/viral infections promptly; consider mupirocin for localized lesions
- Psychological support for itch-scratch cycle
Living with AD
- Track flares, triggers (foods, stress, weather), daily skincare, medications
- Wear breathable fabrics, maintain humidified environment
- Practice stress reduction (mindfulness, therapy)
- Connect with support groups; AD affects self-esteem and social life
Complications
- Lichenification, dyspigmentation, scarring
- Eczema herpeticum, bacterial superinfections
- Sleep deprivation, mental health disorders
- Hand eczema impacting work
Research & Future Directions
New biologics/JAK inhibitors targeting IL-31, IL-22, TSLP, OX40, and barrier repair therapies are rapidly evolving.
Experimental & Emerging Treatments
- IL-31 Receptor Antagonists (nemolizumab): Target itch signaling.
- TSLP & OX40 Inhibitors: Block upstream triggers of type 2 inflammation.
- Microbiome Therapies: Topical probiotics or commensal transplant to restore balance.
- mRNA/siRNA Topicals: Aim to boost filaggrin or suppress inflammatory pathways locally.
Track AD with Diagnoza.care
Calm Your Skin Routine – Log daily skincare, flares, itch scores, sleep, medications, infections, phototherapy, biologic injections, and dermatology visits; capture side effects; and let the AI companion highlight triggers and treatment response.
Medical Disclaimer: Informational only. Work with your dermatologist/allergist to tailor skincare routines, topical/systemic therapies, and infection prevention strategies.
Sources: American Academy of Dermatology, European Task Force on Atopic Dermatitis, National Eczema Association