Advances in atopic dermatitis

Abstract

Atopic dermatitis (AD) is a common inflammatory skin disease characterised by itch and is responsible for significant reduction in quality of life. While AD primarily arises in those under the age of 2 years, it is frequently persistent into adulthood. Recognition of AD is important for the general physician, especially to distinguish causes of acute flares that may present in any medical setting, such as eczema herpeticum and associated allergic reactions. While, to date, treatments have largely focused on broad spectrum immunomodulation with corticosteroids or systemic therapies (such as ciclosporin and methotrexate), increased knowledge in the pathophysiology of the disease has recently led to the expansion of treatment options available for those suffering with AD, and the new drugs on the horizon promise a previously unimagined potential for effective and safe treatment.

Keywords: JAK inhibitors; atopic eczema; dermatitis; dupilumab.

Fig 1.

Lichenified (thickened), scaly skin over flexural sites of chronic eczema. Inflammation is evident.

Fig 2.

Lichenified skin at a site of chronic eczema in dark skin, showing hyperpigmentation. Inflammation is not evident.

Fig 3.

Diffuse spread of small vesicles across the face with crusting and scaling in a patient with atopic dermatitis.

Fig 4.

Current principles of atopic dermatitis management. ^aAccording to National Institute for Health and Care Excellence guidance, failure of one systemic immunosuppressant is required before proceeding to step 3; ^bciclosporin and dupilumab are the only licensed systemic therapies for atopic dermatitis.