Clinical aspects of atopic dermatitis

Atopic dermatitis (AD), or atopic eczema, is the most common, chronic inflammatory disease among children in industrialized countries. We still lack knowledge of its pathophysiology and in particular the role of allergy as both an eliciting factor for disease expression and for disease activity. This article describes the clinical symptoms of the disease and its qualitatively different aspects. AD cannot be understood as being induced by one factor only, e.g. allergy, and this is important when planning treatment strategies. It is also important to realize the very wide range of disease intensity: from subclinical, or latent AD, in which only a few symptoms are present and thus which prevents a clear diagnosis of AD, to its most severe forms including erythroderma. It's unknown aetiology, the wide range in symptomatology, and the fluctuating course (including the many eliciting factors) form the background for our diagnostic and therapeutic difficulties of atopic eczema. AD is prevalent in childhood, but the atopic trait continues, not only for later respiratory allergies, but also for skin diseases in adulthood (such as AD itself or the frequent irritant contact dermatitis of the hands). A child with an acute and first attack of AD is therefore a challenge to the child, its parents and - certainly - to the doctor. However, after stressing the chronicity of the disease, it is equally important to assure the parents that this disease is, in most cases, controllable through correct treatment and that it has a good prognosis: It is not a 'life sentence', but a controllable disease in an otherwise healthy child.