Atopic eczema

Abstract

Atopic eczema is an itchy inflammatory skin disease with a chronic relapsing-remitting course; it has increased in prevalence in recent decades and now affects up to 25% of school-aged children in the developed world and up to 10% of adults. Recent advances in understanding the aetiology of eczema have focused interest on skin barrier dysfunction as a common precursor and pathological feature. In addition, genetically determined skin barrier dysfunction (associated with mutations in the gene encoding filaggrin) is known to predispose to multiple systemic atopic diseases. First-line treatments for atopic eczema focus on maintaining and repairing the skin barrier (emollients) and reducing inflammation (topical steroids); allergen and irritant avoidance are also important to achieve disease control. Second and third-line treatments include topical calcineurin inhibitors, ultraviolet light and systemic immunosuppressant therapies of which only ciclosporin is licenced for the treatment of atopic eczema in adults. Novel biological therapies are in phase II-III clinical trials.

Keywords: Atopic; barrier; dermatitis; eczema and filaggrin.

Fig 1.

Child with moderate-severe atopic eczema. The child's upper limb shows multiple areas of eczematous inflammation in flexural and non-flexural sites, on a background of generalised ichthyosis vulgaris (common dry, scaly skin).

Fig 2.

Adult severe atopic eczema. The skin on this adult's upper back shows widespread erythema and scaling, indicative of active eczema, with multiple excoriations.