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- A chronic, relapsing, pruritic eczematous condition affecting characteristic sites
- Although called atopic, most children with the typical clinical presentation will not have a measurable IgE-mediated sensitivity to allergens.
- System(s) affected: Skin/Exocrine
Environmentally triggered in susceptible individuals
- 45% of all cases begin in the first 6 months of life.
- 70% of affected children will have a spontaneous remission before adolescence.
- Incidence on the rise for the past 3 decades; overall, affects ∼15% of children at some time (US).
- Also may have late-onset dermatitis in adults
- Asians and blacks affected more often than whites
- 60% if 1 parent affected; rises to 80% if both parents affected
Etiology and Pathophysiology
- Alteration in stratum corneum results in transepidermal water loss and defect in barrier function.
- Epidermal adhesion is reduced either as a result of: (a) Genetic mutation resulting in altered epidermal proteins or (b) defect in immune regulation causing an altered inflammatory response.
- Interleukin-31 (IL-31) upregulation is thought to be a major factor in pruritus mediated by cytokines and neuropeptides rather than histamine excess (1).
- Arises from gene–gene and gene–environment interactions
- Both epidermal and immune coding likely involved
- “Itch-scratch cycle” (stimulates histamine release)
- Skin infections
- Emotional stress
- Irritating clothes and chemicals
- Excessively hot or cold climate
- Food allergy in children (in some cases)
- Exposure to tobacco smoke
- Family history of atopy:
- Allergic rhinitis
Commonly Associated Conditions
- Food sensitivity/allergy in many cases
- Allergic rhinitis
- Hyper-IgE syndrome (Job syndrome):
- Atopic dermatitis
- Elevated IgE
- Recurrent pyodermas
- Decreased chemotaxis of mononuclear cells