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Atopic Dermatitis
Atopic Dermatitis
Atopic dermatitis (AD) also known as atopic eczema or eczema is a type of dermatitis, an inflammatory,
relapsing, non-contagious and itchy skin disorder. It has been given names like "prurigo Besnier,"
"neurodermatitis," "endogenous eczema," "flexural eczema," "infantile eczema," and "prurigo diathsique".
Atopic dermatitis is very common worldwide and increasing in prevalence. It affects males and females equally
and accounts for 10%-20% of all referrals to dermatologists (doctors who specialize in the care and treatment
of skin diseases). Atopic dermatitis occurs most often in infants and children, and its onset decreases
substantially with age. Scientists estimate that 65% of patients develop symptoms in the first year of life, and
90% develop symptoms before the age of 5. Onset after age 30 is less common and often occurs after
exposure of the skin to harsh conditions. People who live in urban areas and in climates with low humidity
seem to be at an increased risk for developing atopic dermatitis.
About 10% of all infants and young children experience symptoms of the disease. Roughly 60% of these
infants continue to have one or more symptoms of atopic dermatitis even after they reach adulthood.
2) Causes of AD
The cause of atopic dermatitis is not known, but the disease seems to result from a combination of genetic
(hereditary) and environmental factors. There seems to be a basic hypersensitivity and an increased tendency
toward itching. Evidence suggests that the disease is associated with other so-called atopic disorders such as
hay fever (seasonal allergies) and asthma, which many people with atopic dermatitis also have. In addition,
many children who outgrow the symptoms of atopic dermatitis go on to develop hay fever or asthma. Although
one disorder does not necessarily cause another, they may be related, thereby giving researchers clues to
understanding atopic dermatitis. It is important to understand that food sensitivities do not seem to be a major
factor with most atopic dermatitis. This is an area of active research. Patients with atopic dermatitis seem to
have mild immune system weakness. They are predisposed to develop fungal foot disease and cutaneous
staphylococcal infections, and they can disseminate herpes simplex lip infections (eczema herpeticum1) and
smallpox vaccination (eczema vaccinatum2) to large areas of skin.
Mutations of the gene encoding TLR2 are associated with severe forms of AD (with recurring bacterial
infections) as when an allergen crosses the epidermal barrier, it comes in contact with toll-like receptors
(TLRs) expressed by skin cells, the 1st line of defense against infections
Reduced activity of beta-defensins 2 and 35. This reduction in the skin's natural antimicrobial peptides 6is
induced by the strong presence of pro-inflammatory cytokines7 (IL3,IL4,IL5,IL13) produced by the Th2
lymphocytes8
Reduced innate immunity (beta-defensins 2 and 3) is why, in 90% of cases, atopic skin is colonized by
staphylococcus aureus bacteria. The toxins produced by S.aureus increase inflammation and cause the
production of specific IgEs. The ceramidases synthesized by S.aureus alter the skin's barrier function.
The hyper-reactivity of the immune system triggers the release of numerous pro-inflammatory
mediators and immunoglobulin E (IgE) 9
In the case of extrinsic or allergic atopy (actual AD), specific immunoglobulins Es (IgEs) are released Other
symptoms: rhinitis, asthma.etc.
is a rare but severe disseminated infection that generally occurs at sites of skin damage produced by, for example, atopic
dermatitis, burns, long term usage of topical steroids or eczema
2
is a rare severe adverse reaction to smallpox vaccination.
3
Squames begin life as normal cells in the lower layers of the epidermis but, as they travel towards the surface, they
progressively lose all recognizable contents.
4
Ichthyosis is characterised by persistently dry, thickened, rough, fish scale skin. There are at least 20 varieties of ichthyosis,
including inherited and acquired forms.
5
The beta defensins are antimicrobial peptides implicated in the resistance of epithelial surfaces to microbial colonization.
6
A peptide is a chemical compound containing two or more amino acids (amino acid polymers) that are coupled by a
peptide bond. This bond is a special linkage in which the nitrogen atom of one amino acid binds to the carboxyl carbon atom
of another.
7
Cytokines are cell signaling molecules that aid cell to cell communication in immune responses and stimulate the
movement of cells towards sites of inflammation, infection and trauma.
8
Lymphocytes are small white blood cells that play an role in the bodys immune response (that is, in the bodys fight
against germs and diseases).There are two main types of lymphocytes, known as B cells and T cells (also known as B
lymphocytes and T lymphocytes). The B cells produce antibodies that attack foreign molecules (germs and the toxins they
produce). The T cells are more complicated, but they can attack the bodys own cells when they are diseased (for example,
when the cells have been invaded by cancer or viruses).
Substances secreted by lymphocytes (called lymphokines) contribute to inflammation. Wherever there is chronic
inflammation in the body, lymphocytes are present.
9
IgE: specific antibodies synthesized during the allergic reaction.