Epidemiologic, pathogenic, clinical and diagnostic aspects of atopic dermatitis. Is it possible the prevention?

The prevalence of atopic dermatitis (AD) has doubled or three-folded in industrialized countries. There are often data of family history of atopic diathesis, suggesting that there is a genetic predisposition in these patients. The incidence is similar in both sexes, but the significant ethnic background and geographic differences point out the importance of environmental factors in the development of the disease.

To understand the physiopathology, it is necessary to take into account genetic abnormalities, dermal barrier impairment, immune system disturbances and the increased susceptibility of DA patients to suffer from microbial infections. Given that the immunopathological mechanisms of AD are not yet well understood, it is impossible to modify them to change the course of the disease. For example, delaying artificial lactation or the timing of introduction of solid food, as well as performing dietary restrictions in pregnant women, have not shown to have a protective effect in AD. However, it seems to be important to treat cutaneous lesions to prevent allergic sensitization through the skin, which might lead to asthma or rhinoconjuntivitis in these patients.

Pruritus and recurrences are the clinical hallmark of the disease. The diagnosis is usually made straightforward based on clinical features, but the pediatrician may need specialized help occasionally, either to confirm the diagnosis or to manage severe cases.

Keywords: Atopic dermatitis. Epidermal barrier. Innate immunity. Atopic march.