eCase Challenge: New Approaches to the Management of Atopic Dermatitis

Atopic dermatitis (AD) is a common inflammatory, pruritic, noncontagious skin disease associated with a chronic, relapsing course. According to a National Health Interview Survey conducted by the National Center for Health Statistics, Centers for Disease Control, the 1-year prevalence of AD is 10.2% in the United States. Other studies, including those conducted by the International Study of Asthma and Allergies in Childhood, have found that the prevalence of AD is between 15% to 20% in children and 1% to 3% in adults.

Characteristic symptoms of AD include skin rashes and severe itching. The disease often begins in newborn children 8 to 12 weeks old who have “cradle cap” on the scalp, a classic sign of AD. The development of rashes, itching, oozing, and crusting on the face and extensor surface of the extremities can persist through childhood and, for some individuals, into adulthood.

AD causes both acute and chronic symptoms. Acute symptoms include red skin, itching, and weeping blisters. When chronic or long-term symptoms are present, patients may experience dry and cracked skin that can thicken. The symptoms of AD vary in intensity—resolving, perhaps not fully, then flaring with significant worsening.

The diagnosis of AD is made clinically, as there are no specific imaging or laboratory tests that individually or collectively can be used to establish the presence of the disease. Guidelines for the diagnosis of AD have been available for more than a decade. The American Academy of Dermatology (AAD) has established guidelines for diagnosing AD in both adult and pediatric populations.

Educational Objectives
At the conclusion of this activity, the PA should be better able to:
  • Recognize AD in the clinic setting.
  • Differentiate AD from other dermatologic conditions.
  • Outline the current understanding of the pathophysiology of AD, including the various components of the immune system that are involved.
  • Use newer agents appropriately in the treatment of AD weighing mechanisms of action and their potential advantages and limitations.
Monograph also available. The monograph is a supplement of the November 2019 JAAPA.