Atopic dermatitis

Abstract

Atopic dermatitis (AD) and atopic eczema are interchangeable names for a condition that affects 15–30% of children and up to 10% of adults. Filaggrin plays a key role in epidermal barrier function; null mutations in the filaggrin gene are associated with AD, with resultant barrier dysfunction. AD affects many aspects of family life. Patient and parent education is an important aspect of management. Emollients applied frequently, even when the eczema has resolved, help prevent flares. Appropriate use of topical corticosteroids is still a mainstay of treatment. Topical calcineurin inhibitors can be useful immunomodulators, particularly in children. Intermittent use of sedative antihistamines and oral or topical antibiotics can be required. In a secondary care setting, it is often more effective to gain control of the disease using a combination of treatments and then maintain control once this is achieved. Second-line treatments with narrow-band ultraviolet B or immunosuppressive drugs such as ciclosporin or methotrexate can be required for chronic severe AD. The biological agents dupilumab and tralokinumab are now established for use in patients with moderate-to-severe AD who are candidates for systemic therapy. Baricitinib, an inhibitor of the Janus kinases JAK1 and JAK2 is a relatively new oral treatment for this patient group, and has been approved by the National Institute for Health and Care Excellence (NICE) in the UK.