Understanding Atopic Dermatitis: Pathophysiology and Management Strategies

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by itching, redness, and dryness, significantly impacting the quality of life of affected individuals. With a rising prevalence across diverse demographics, understanding AD is crucial due to its systemic nature and association with comorbidities such as asthma and allergic rhinitis, as well as its psychosocial implications. The pathophysiology of AD involves a complex interplay of genetic predispositions and environmental triggers, leading to dysbiosis and increased susceptibility to superinfection. Clinically, AD manifests variably across age groups, with distinct presentations in pediatric and adult populations. Diagnosis is primarily based on clinical assessment criteria, supplemented by differential diagnoses and, when necessary, skin tests for allergies. Current management strategies encompass topical therapies, including moisturizers, corticosteroids, and calcineurin inhibitors, alongside systemic treatments such as antihistamines, immunosuppressants, and biologics. Lifestyle modifications, including trigger avoidance and effective skin care routines, are essential components of comprehensive care. Emerging novel therapies targeting specific biomarkers are currently under investigation in clinical trials, offering promising avenues for more effective management. However, challenges remain in optimizing treatment protocols and addressing the multifaceted nature of AD. In conclusion, this review highlights the need for continued research and awareness regarding atopic dermatitis. A multidisciplinary approach to management is essential to enhance patient outcomes and address the complexities of this prevalent and impactful condition.

Keywords: atopic dermatitis; management; pathophysiology.

Figure 1

Pathophysiology and targeted therapy for AD.

Figure 2

Representative images of AD. (A) A 4-year-old child presenting with AD on the hands. (B) A 14-year-old child exhibiting exudative AD on the flexor surfaces of the lower limbs. (C–E) A 32-year-old man with AD affecting both the upper trunk and lower limbs.

Figure 3

Clinical improvement in a patient with severe AD following Dupilumab treatment. A 65-year-old woman has been given 300 mg Dupilumab by subcutaneous injection every other week for 40 weeks. (A) Representative photographs of the lower limbs at baseline (prior to treatment). (B) Corresponding photographs taken after treatment. (i) right view, (ii) left view, (iii) posterior view.