Atopic Dermatitis Part 1: Pathophysiology, Clinical Manifestations, and Associations

Atopic dermatitis (AD), or eczema, is a common, chronic inflammatory skin condition resulting in recurrent flares of itch and rash. This review discusses current literature regarding epidemiology, pathophysiology, etiology, comorbidities, clinical presentation, and impact on quality of life with the goal of addressing common gaps in understanding. Onset is usually early in life, but it is not uncommon to persist into adulthood, despite a common assumption that children outgrow AD. The primary drivers of its pathophysiology are skin barrier dysfunction and immune dysregulation, which are complex and interrelated. The etiology is influenced by genetic, microbial, immunological, and possibly environmental factors. A notable predictor of AD is a family history of atopic disease. Comorbidity with other atopic diseases including asthma and food allergies is common. Nonatopic comorbidities common in AD include autoimmune conditions and psychiatric diseases. Clinical manifestations include the almost universal feature of pruritus, which can be seen without rash. Rash can include classic dermatitis, but other morphologies including those more common in patients with skin of color should be recognized. Complications such as secondary infection are common, often related to the complex role Staphylococcus aureus plays in AD. Living with AD places a significant burden on the patient's quality of life including significant impacts on sleep. Assessment of severity includes assessing itch severity and impact on quality of life. Tools such as a numeric rating scale for itch severity may be useful in clinical practice.