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Recent research states that atopic dermatitis (AD) is a
disease of the immune system. IL-4 and IL-13 cytokines involved in Th2 pathway
and IL-22 cytokine in the Th22 pathway. These cytokines cause skin barrier
defects and inflammation which results in the clinical characteristics of
AD.(4) Therefore, a phenotype of this disease is associated with activation of
Th2 and Th22 T-cells. Mutations in the gene encoding protein filaggrin play
role in exposure to allergens and microbial pathogens and induce polarization
of Th2; Th22 cells play roles in skin barrier impairment through IL-22.(3)
Atopic dermatitis associated with an imbalance of TH cells, with a lot more Th2
cells and cytokines associated with them. In addition, there are also increased
levels of IgE antibodies and eosinophils.(1)

2.How common is this disease? Are there any particular
susceptibility groups?

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Even though it’s the most common form of eczema, it’s also
the most severe and long-lasting. Children often get atopic dermatitis during
first six months of their life and according to the American Academy of
Dermatology, females are more likely than males to get an AD. Although food
doesn’t cause AD, food allergies to dairy products, shellfish and nuts may
worsen eczema.  Recent studies have shown
that infants, who get AD usually have family members who have allergies, AD,
asthma or hay fever which means that there is a genetic predisposition to AD.
In addition, living in cold climate and in developed country; mother’s age at
the time of the childbirth and in addition may play role in development of
AD.(2) Atopic dermatitis in infants may improve over the time and might even
disappear as a child grows older, but in some cases, they will continue to
experience symptoms of AD trough adulthood.

3.What are the disease symptoms? Signs and symptoms of
atopic dermatitis are varying in different age groups. For instance, Infants
can get an AD as early as 2 or 3 months old. 
A rash can appear suddenly on the scalp, forehead and very often on the
cheeks making skin dry, scaly, and itchy which may come and go. Infants may
have trouble sleeping because they rub and scratch skin which can lead to skin
infection (5).

In case if AD begins between 2 years of age and puberty, rash
starts in the elbows creases or knees and later appears on the neck, wrists,
ankles and even in the crease between the legs and buttocks which lead to scaly
itchy patches. Over the time, the skin gets bumpy and thickens.

Symptoms of AD in adults vary from person to person because
AD can appear on different parts of the body: face, eyelids, neck, upper chest
as well as in the creases of the knees, feet, elbows and wrists. Skin appears
very dry, sometimes cracked and much scalier than children. People why had
atopic dermatitis for many years may have itchy thick patches of skin usually
darker than the rest of the skin.(2)

4.What mechanisms are responsible for these disease
symptoms?

 Impaired skin barrier
function plays role in the development of atopic dermatitis. Deficiency of
filaggrin- proteins that bind to keratin fibers in the epidermal cells which
decrease natural moisturizing factors, flattening of surface skin cells, disruption
of  lamellar bilayers structure and
rising of skin pH which stimulates production of cytokines IL-1alpha and
IL-1beta  by serine protease and
stimulate inflammation. Cytokines associated with Th2 contribute to increasing
permeability and water loss through the skin (which makes it easier for the
irritants and allergens to penetrate the skin), reducing fatty acids. In
addition, it may decrease the number of antimicrobial peptides which can lead
to colonization of bacteria in affected area.(4) Keratinocytes producing thymic
stromal lymphopoietin that activates myeloid dendritic cells may affect Th
cells imbalance even further. High numbers of mast cells in skin lesions
associated with atopic dermatitis and releasing of pruritogenic substances by
mast cells cause scratching that further damage the skin barrier.(3)  

5.How is the diagnosis made? What particular clinical tests
are used to make this diagnosis?   

To identify atopic dermatitis lab tests are not necessary. A
doctor can diagnosis based on examination of the skin and analysing medical
history and asking questions about potential food allergies and triggers such
as pollen, dust, sweat, soaps, detergents and stress that might worsen the
condition. In addition, they may ask a patient to do a patch testing which
involves placing very small amounts of allergens on the skin and checking skin
for reactions after a few hours, then after 24 and 72 hours.(1)

6.What is the prognosis for someone with this disease?

Atopic dermatitis can be persistent. People with AD often
try different treatments for many months and sometimes even years to control
it. Unfortunately, even with successful treatment, signs and symptoms may
return. Studies have found that if an infant or young child develops an AD, it
tends to get better with time. For some children, the condition completely
disappears by age 2; however, about 50% of the children who get AD will have it
as an adult. Since there are so many complications AD patients may experience
such as hay fever, asthma, skin infections and contact dermatitis, it is very
important to diagnose a condition and start treatment as soon as possible.(1)

7.What are the treatment options?

Treatments can’t cure AD, but can keep it under control. To
control itching hydrocortisone can be applied to affected area and
antihistamines such as Zyrtec or Allegra can be used. In addition, inhibitors
of calcineurin such as Elidel and Protopic can be prescribed. To treat skin
infections, antibiotic cream or oral antibiotics prescribed. To control
inflammation oral corticosteroids such as prednisone can be used.  For people with severe atopic dermatitis who
do not respond well to other treatments, FDA has recently approved a new
injectable monoclonal antibody called Dupixent. Studies have shown that it is
effective and safe but very expensive. For people with widespread lesions
wrapping the affected area with topical corticosteroids and wet bandages is
another treatment option. (2) In cases, when topical treatments don’t work or
if patients very fast flare again after treatment light therapy which involves
exposing the skin to narrow band ultraviolet B and ultraviolet A may be used.
Some people become ashamed and even upset by the condition of their skin over
the time may develop an anxiety and depression. In this case, seeing a
psychologist might be very helpful.(1)

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