Atopic eczema is a common disease affecting up to 15% of children.
- Both genetic and environmental factors play a role
- Atopic dermatitis usually occurs in people who have an 'atopic tendency'. This means they may develop any or all of three closely linked conditions; atopic dermatitis, asthma and hay fever (allergic rhinitis). Often these conditions run within families with a parent, child or sibling also affected
- Current evidence points to mutations in the filaggrin gene being likely to underlie almost half the cases of atopic eczema. Filaggrin is critical to the conversion of keratinocytes to the protein / lipid squames that compose the stratum corneum, the outermost barrier layer of the skin. A primary defect in the skin barrier function therefore appears to underlie atopic eczema, and immunological changes are probably secondary to enhanced antigen penetration through a deficient epidermal barrier. The relevance of this finding is that it reinforces the importance of the regular use of emollients to help manage eczema
- Involvement of the face frequently occurs in infants with adoption of characteristic flexural distribution by the age of 18 months
- Spontaneous improvement tends to occur throughout childhood with complete clearance by teenage years in 50%.
- Realistic treatment aims need to be discussed with the patient and parents.
Referral Criteria:
Referral for specialist dermatological advice is recommended if:
- the diagnosis is, or has become, uncertain
- management has not controlled the atopic eczema satisfactorily based on a subjective assessment by the child, parent or carer (for example the child is having 1–2 weeks of flares per month or is reacting adversely to many emollients)
- atopic eczema on the face has not responded to appropriate treatment
- the child or parent/carer may benefit from specialist advice on treatment application (for example, bandaging techniques)
- contact allergic dermatitis is suspected (for example, persistent atopic eczema or facial, eyelid or hand atopic eczema)
- atopic eczema is associated with severe and recurrent infections, especially deep abscesses or pneumonia.