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Introduction
Atopic eczema is a chronic, relapsing, inflammatory skin condition associated with epidermal barrier dysfunction. This article provides a summary of current knowledge on eczema and its management.
Sources and selection criteria
We used the following sources of information to write this review:
PubMed search using the key words "atopic eczema", "atopic dermatitis", "incidence", "genetics", "pathogenesis", "treatment", and "management". We gave preference to original articles published in the past three years and recent review articles published in high impact journals
Search of the following Cochrane Library databases: Cochrane Database of Systemic Reviews; Database of Abstracts and Reviews of Effectiveness; Cochrane Central Register of Controlled Trials
Personal archive of references.
How do we define atopic eczema?
Atopic eczema and atopic dermatitis are terms that have been used synonymously (for a clinical definition see box), but a review committee by the World Allergy Organisation has published its recommended terminology (see fig 1 ). 1
Eczema is subdivided into atopic and non-atopic eczema because a proportion of patients exhibit eczema without atopic features. Children with atopic eczema are more likely than those with non-atopic eczema to develop asthma later in life, and their eczema more often persists into adulthood. However, atopic and non-atopic eczema have not been shown to respond differently to treatment, and patients with non-atopic eczema may subsequently develop atopic features.
Summary points
Atopic eczema is an itchy inflammatory skin condition with associated epidermal barrier dysfunction
The prevalence of atopic eczema seems to be rising, but the factors responsible for this rise are not fully understood
The pathophysiology of eczema involves systemic as well as cutaneous immune and epidermal dysfunction
Eczema is a complex trait with significant genetic and environmental influences
Emollients and topical steroids are the mainstay of treatment for mild to moderate eczema; moderate to severe eczema may require the addition of second line agents such as topical or systemic calcineurin inhibitors, ultraviolet phototherapy, or systemic azathioprine
A clearer understanding of the genetic basis and pathophysiology of eczema is expected to lead to new improved treatments
The results of future studies relating clinical features, pathogenesis, and molecular genetics may lead to a clearer understanding and more accurate subclassification of eczema.
Why is eczema important?
Itch as a symptom is often underestimated in terms of...