Denitza Zheleva*and Razvigor Darlenski
Department of Dermatology and Venereology, Tokuda Hospital Sofia, Bulgaria
Received: 10 February, 2017; Accepted: 23 February, 2017; Published: 24 February, 2017
Denitza Zheleva, Department of Dermatology and Venereology, Tokuda Hospital Sofia, 51B, Nikola Vaptzarov blvd, 1407 Sofia, Bulgaria, Tel: 00359 895 788551; E-mail:
Zheleva D, Darlenski R (2017) Atopic Eczema - From Epidemiology to Therapeutic Approach. Glob J Allergy 3(1): 004-010. DOI: 10.17352/2455-8141.000016
© 2017 Zheleva D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Atopic dermatitis is one of the epidemically expanding non-infectious diseases in the 21 century. It poses immense challenges to both patients and physicians. With a steady growth in its incidence and prevalence, the disease carries a heavy social and economical burden. Herein we discuss the therapeutic algorithm for atopic dermatitis in accordance with the disease severity. We emphasize on the personalized approach in selecting the proper treatment method and regimen for each patient.
Atopic dermatitis (AD, syn. ‘atopic eczema’) is the commonest inflammatory skin disorder in children and represents a serious problem for the providers of health care all over the world [1-4] with an impressive effect on patients’ quality of life [1,5-9]. In 40–60% of paediatric patients with AD persist having symptoms later on in life [10,11]. Although AD often starts in early infancy, there are adult onset forms which start in adolescence or adulthood . Most of the patients with AD can control their skin disease with topical therapy and emollient skin care. There is a considerable group of patients with severe AD who do not respond to the prescribed treatment with moisturizers, topical corticosteroids (TCS), and/or topical calcineurin inhibitors (TCI) or experience immediate flare-ups after tapering topical anti-inflammatory therapy.
The European Academy of Allergology and Clinical Immunology (EAACI)  suggested definition of the term atopy – ‘a personal or familial tendency to produce IgE antibodies in response to low doses of allergens, usually proteins, and to develop typical symptoms of asthma, rhinoconjunctivitis or eczema/dermatitis’. As an alternative term the authors also suggested ‘atopic eczema/dermatitis syndrome’ . In 2003, the Nomenclature Review Committee of the World Allergy Organization (WAO) updated the EAACI 2001 position statement  and suggested that the term ‘eczema’ should replace the provisional term ‘atopic eczema/dermatitis syndrome’. The update further suggested that ‘eczema’ could be subclassified as ‘atopic eczema’ and ‘nonatopic eczema’ according to the presence or absence of IgE antibodies.
The pathophysiology and clinical phenotype of AD are very heterogeneous and change from patient to patient as well as within the history of a given patient. The disease has great impact over patients’ quality of life and beyond, a socio-economic burden. Moderate to severe AD causes over two billion euro in lost productivity in the European Union (EU) every year [14,15]. Lapidus et al., estimated that the annual amount spent on ambulatory care, emergency department care, inpatient care, and outpatient prescriptions for American children with AD is US$364 . The cost of medical services and prescription drugs was estimated to be between US$0.9 and US$3.8 billion in the United States between 1997 and 1998.
For the last 30 years there is a dramatic increase in the prevalence of AD. It has increased from 9% to 12% for 10 year period between 1960 and 1970 , and nowadays the prevalence is approximately between 15-20% [10,18]. In developed countries it is currently estimated between 10-20% for children and 1-3% for adults. Last studies reveal that the prevalence range in various borders according to the goegraphic regions and the environmental factors. It varies for different countries: less than 1- 2% in Iran and Albania, approximately 11 % for the United States, up to 16-17% in Japan and Nigeria. The Australasia and Northern Europe shows higher prevalences of the condition, while the prevalences reported in Eastern and Central Europe and Asia is lower . AD often starts in early infancy; approximately 45% of all cases begin within the first 6 months of life, 60% during the first year, and 85% before 5 years of age. Up to 70% of these children outgrow the disorder before adolescence . The prevalence of AD continues to increase, particularly in young children from low-income countries, such as in Africa and East Asia, where there is also often an urban–rural gradient of disease.
There is a wide variety of treatment strategies that has been established for AD. For most of the patients a combination of emollient and anti-inflammatory therapy is regarded as an optimal choice [21,22] (Table 1). A step-wise approach to AD treatment with regard to the disease severity is presented at Figure 1.
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