title: Atopic dermatitis: an overview.
abstract: Atopic dermatitis, also known as atopic eczema, is a chronic pruritic skin condition affecting approximately 17.8 million persons in the United States. It can lead to significant morbidity. A simplified version of the U.K. Working Party's Diagnostic Criteria can help make the diagnosis. Asking about the presence and frequency of symptoms can allow physicians to grade the severity of the disease and response to treatment. Management consists of relieving symptoms and lengthening time between flare-ups. Regular, liberal use of emollients is recommended. The primary pharmacologic treatment is topical corticosteroids. Twice-daily or more frequent application has not been shown to be more effective than once-daily application. A maintenance regimen of topical corticosteroids may reduce relapse rates in patients who have recurrent moderate to severe atopic dermatitis. Pimecrolimus and tacrolimus are calcineurin inhibitors that are recommended as second-line treatment for persons with moderate to severe atopic dermatitis and who are at risk of atrophy from topical corticosteroids. Although the U.S. Food and Drug Administration has issued a boxed warning about a possible link between these medications and skin malignancies and lymphoma, studies have not demonstrated a clear link. Topical and oral antibiotics may be used to treat secondary bacterial infections, but are not effective in preventing atopic dermatitis flare-ups. The effectiveness of alternative therapies, such as Chinese herbal preparations, homeopathy, hypnotherapy/biofeedback, and massage therapy, has not been established.
authors.affiliation: Kaiser Permanente's Woodland Hills Family Medicine Residency Program, Woodland Hills, CA, USA. Rebecca.g.berke@kp.org
authors.forename: Rebecca
authors.initials: R
authors.lastname: Berke
authors.forename: Arshdeep
authors.initials: A
authors.lastname: Singh
authors.forename: Mark
authors.initials: M
authors.lastname: Guralnick
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology; D065095:Calcineurin Inhibitors; D002921:Cicatrix / Q000209:etiology; D000529:Complementary Therapies; D003876:Dermatitis, Atopic / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D003879:Dermatologic Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D004643:Emollients / Q000627:therapeutic use; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D010789:Phototherapy; D011537:Pruritus / Q000209:etiology / Q000517:prevention & control; D012867:Skin / Q000382:microbiology; D016559:Tacrolimus / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D065095:Calcineurin Inhibitors; D003879:Dermatologic Agents; D004643:Emollients; D006633:Histamine Antagonists; C117268:pimecrolimus; D016559:Tacrolimus