Mark Boguniewicz

Atopic Dermatitis and Allergic Contact Dermatitis

Abstract Atopic dermatitis is the most common chronic skin disease of young children, with a lifetime prevalence in US schoolchildren of up to 17%. Abnormal skin barrier differentiation and immune response genes play key roles in atopic dermatitis. Additionally, frequent colonization and infection by microbial organisms, in particular Staphylococcus aureus and Herpes simplex virus in patients with atopic dermatitis, reflect the complex underlying skin pathophysiology. Treatment regimens for most patients with chronic atopic dermatitis include avoidance of irritants and proven allergens with aggressive hydration and application of moisturizers to maintain a healthy epidermis. Antimicrobial therapy is included for acute infections, and topical anti-inflammatory agents, particularly corticosteroids and calcineurin inhibitors, are the mainstay of therapy. Systemic immunomodulatory agents should be reserved for patients with proven recalcitrant disease. As even non-lesional skin in patients with atopic dermatitis is not normal with respect to skin barrier and immune abnormalities, proactive (maintenance) therapy may be appropriate for a subgroup of patients with relapsing disease.

Atopic and Contact Dermatitis

Abstract Atopic dermatitis (AD) and contact dermatitis (CD) are common inflammatory skin diseases. The complex pathophysiology of AD involves both underlying skin barrier abnormalities and immune dysregulation. Its course is augmented by environmental influences including stress, allergen exposure, and microbial infection. AD patients with a relapsing course benefit from a proactive approach with skin emollients and antiinflammatory approaches, e.g., intermittent use of a topical steroid or calcineurin inhibitor. The identification of new immune pathways associated with AD has resulted in the development of novel biologicals targeting refractory patients with AD.