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ATOPIC DERMATITIS

Jun

2008

Vol. 27. No. 2

Introduction

This issue of Seminars in Cutaneous Medicine and Surgery is dedicated to atopic dermatitis. Atopic dermatitis is one of the most prevalent skin diseases found in dermatology practices, and these patients are often uncomfortable, sleep poorly, and are frustrated with their disease and the available treatment options. Many experiment with multiple conventional and unconventional treatments in search of the “cure.” While our patients struggle to manage their disease, we strive to take better care of them by remaining up-to-date on advances in clinical and basic science research and their application to our practices. To further those efforts, my goal as editor of this issue was to include a balance of clinically relevant basic science and practical clinical issues related to atopic dermatitis. The contributing authors for this issue are an esteemed group of clinicians and scientists. Dr. Alan Irvine and colleague Sara Brown lead with their comprehensive review on the association of the filaggrin gene mutations with atopic dermatitis. This finding has been one of the most written about and researched topics in atopic dermatitis in the past several years, and we remain hopeful that this finding will lead to new therapies. Dr. Jeffrey Sugarman authored the review of the epidermal barrier abnormalities in atopic dermatitis. The discovery of barrier defects has greatly impacted our daily practices and feeds a growing market of repair products. We hope that barrier repair will help stop the “atopic march,” therefore, preventing future morbidity from other atopic conditions. Dr. Tissa Hata and Dr. Richard Gallo thoroughly review the role of antimicrobial peptides and skin infections in atopic dermatitis, and Dr. Elif Dokmeci and Dr. Christina Herrick stress the importance of the immune system in atopic dermatitis in their manuscript. Dr. Boguniewicz and colleagues provide an exciting window into their multidisciplinary clinic developed at the National Jewish Medical and Research Center. The problems and “roadblocks” many of us face treating patients with severe atopic dermatitis could be solved with this type of structured program, and I applaud their commitment to this patient population. Dr. Andrew Krakowski and Dr. Magdalene Dohil have written a pediatric dermatologist’s approach to appropriate topical therapy for children with atopic dermatitis and have provided a primer on wet wrap therapy. Many parents of children with atopic dermatitis want to know if their child’s atopic dermatitis is caused by a food allergy. Dr. Kim’s article will help the practicing dermatologist navigate this controversial topic. Finally, Dr. Arash Akhavan and Dr. Donald Rudikoff provide a review on the use of systemic immunosuppressive therapy in atopic dermatitis patients. It has been a pleasure to work with this group of expert authors. Their contributions contain thorough and relevant information that we hope will be useful to both practicing dermatologists and scientists.

Atopic Dermatitis: Systemic Immunosuppressive Therapy

Andrea L. Zaenglein, MD | Arash Akhavan, MD | Donald Rudikoff, MD | Joe Ramirez

Atopic dermatitis (AD) is a pruritic, relapsing skin disorder that negatively impacts the
quality of life of those affected and that of their families. Treatment options for AD
encompass a variety of emollients, topical corticosteroids, topical immunomodulators,
phototherapy, and systemic agents. Such agents as systemic corticosteroids, cyclosporine,
azathioprine, interferon-, methotrexate, and mycophenolate mofetil have been shown
to be efficacious in the treatment of moderate-to-severe AD but are not officially approved
for this purpose. In this article, we review some of the data supporting efficacy of these
medications and discuss some of the adverse events associated with their use.
Semin Cutan Med Surg 27:151-155 © 2008 Elsevier Inc. All rights reserved.

Pediatric Atopic Dermatitis: The Importance of Food Allergens

Jennifer S. Kim, MD

Food allergy and atopic dermatitis often occur in the same patients. Food-induced eczema
may be perceived as a controversial topic because the immunologic mechanisms have yet
to be fully elucidated. Nevertheless, published clinical studies have clearly demonstrated
that foods can induce symptoms in a subset of patients with atopic dermatitis. Those at
greatest risk are young children in whom eczematous lesions are severe or recalcitrant to
therapy. Allergy testing can be helpful but must be applied judiciously. A medical history
obtained by a skilled and knowledgeable health care provider is of paramount importance
to interpret test results appropriately. Finally, the implementation of proper dietary avoidance
can improve symptoms and provide safety from potentially fatal anaphylaxis. However,
if inappropriate prescribed, elimination diets can have significant negative nutritional
and social consequences.
Semin Cutan Med Surg 27:156-160 © 2008 Elsevier Inc. All rights reserved.

Topical Therapy in Pediatric Atopic Dermatitis

Andrew C Krakowski, MD | Magdalene A. Dohil, MD

With a prevalence of 10% to 20% in the first decade of life, atopic dermatitis (AD) is one
of the most common skin disorders in young children. It is a chronic illness with limited
therapeutic options. Topical anti-inflammatory agents remain at the core of medical management;
however, their efficacy must be balanced with safety concerns, especially as they
relate to the pediatric population. This article discusses the principles of topical AD therapy
with a detailed review of the differences between topical corticosteroids and topical
calcineurin inhibitors. It also includes specialized topical treatment strategies for AD, such
as wet wraps and diluted bleach baths, and highlights the most common challenges to
patient compliance in atopic dermatitis.
Semin Cutan Med Surg 27:161-167 © 2008 Elsevier Inc. All rights reserved.