Atopic dermatitis: a clinical review for the primary care physician

Atopic dermatitis is a common disease, causing significant morbidity. The histology and cellular mechanisms suggest that atopic dermatitis is an atopic disease similar to asthma and allergic rhinitis, with helper T type 2 lymphocytes being at least a component of the pathogenesis of the disease. Specific allergies, including food allergies, should be explored and treated. Treatment should be directed at increasing the patient's quality of life. Antihistamines, topical steroids, and lubricants are the keystones of therapy. In severe cases, oral steroids may be necessary but should be used sparingly. Interferon, cyclosporine, phototherapy, and immunosuppressive agents may be necessary in refractory cases. It appears that leukotriene inhibitors may have a future role in therapy. Clinical assessment and follow-up are important, as other atopic diseases such as asthma and allergic nasosinus disease may eventually develop in many of these patients.