title: The diagnosis and graded therapy of atopic dermatitis.
abstract: BACKGROUND
  Atopic dermatitis is the most common skin disease in children, with a prevalence of 10% to 15%, and is common in adults as well. Close coordination between primary care physicians and specialists is essential for the adequate treatment of chronically and severely affected patients.
  
  
  METHODS
  This article is a review of pertinent publications that were retrieved by a selective search in Pubmed, with additional consideration of the guidelines of the Association of Medical Scientific Societies in Germany (AWMF) and the European Dermatology Forum.
  
  
  RESULTS
  Trigger factors such as skin irritants, allergens, microbial pathogens, and psychological factors can affect the condition of the skin differently in individual patients and should be individually assessed. The use of skin moisturising creams or emollients along with avoidance of specific and unspecific irritants is of great importance, as these patients have an impaired cutaneous barrier. Topical anti-inflammatory treatment with glucocorticoids or calcineurin inhibitors is a central part of the management of atopic dermatitis; in exceptional cases, severely affected patients are treated with systemic anti-inflammatory drugs. Interdisciplinary patient education has been found to be an effective tool in the complex management of this disease. Chronically and severely affected patients present special challenges for diagnosis and treatment.
  
  
  CONCLUSIONS
  Recent advances in the understanding of the molecular basis of cutaneous barrier disorders and of congenital and acquired immune disorders have led to new approaches to the treatment of atopic dermatitis.
authors.affiliation: Department of Dermatology and Allergology, Hannover Skin Cancer Center, Hannover Medical School.
authors.forename: Thomas
authors.initials: T
authors.lastname: Werfel
authors.affiliation: Clinic for Paediatric Pneumology and Neonatology, Hannover Medical School.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Schwerk
authors.affiliation: Clinic for Paediatric Pneumology and Neonatology, Hannover Medical School.
authors.forename: Gesine
authors.initials: G
authors.lastname: Hansen
authors.affiliation: Department of Dermatology and Allergology, Hannover Skin Cancer Center, Hannover Medical School.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kapp
mesh_terms: D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D065095:Calcineurin Inhibitors / Q000008:administration & dosage*; D003876:Dermatitis, Atopic / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D063465:Skin Cream / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D065095:Calcineurin Inhibitors; D005938:Glucocorticoids