Atopic dermatitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD; Shalinder Singh, M.B.B.S.[2]
Overview
The symptoms of atopic dermatitis usually start during the first few years of life, and present as intense pruritus and chronic and relapsing age dependent eczematous lesions. Common complications of atopic dermatitis include super-infection with staphylococcus aureus, herpes simplex virus, and molluscum contagiosum; sleep problems due to intense pruritus, ocular comorbidities, and striae formation due to long term use of topical corticosteroids.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of atopic dermatitis usually start during the first few years of life, and present as intense pruritus and chronic and relapsing age dependent eczematous lesions.[1]
- The majority of infants and children with atopic dermatitis usually grow out of the disease during childhood.[2]
- In severe cases, atopic dermatitis continues or relapses in adulthood.[3]
- The natural history of atopic dermatitis can be categorized into various subtypes according to the clinical features.
- The most common subtype was characterized by the early onset of atopic dermatitis (<2 years) and persistent until adulthood.[4]
- In the sequence of atopy march diseases, atopic dermatitis is the first to commence during infancy, followed by allergic rhinitis, food allergy and asthma later in life.[5]
- Atopic dermatitis is a life long disease with periods of waxing and waning eczematous skin lesions.[6]
Complications
- Common complications of atopic dermatitis include:
- Super-infection
- Staphylococcus aureus[7][8]
- Herpes simplex virus ( Kaposi varicelliform eruption or eczema herpeticum) - occurs in <3% of patients
- Molluscum contagiosum
- Sleep problems due to intense pruritus
- Ocular comorbidities
- Topical corticosteroids can lead to striae formation
- Atopy march: Other atopic disorders such as allergic rhinitis, food allergy and asthma[8]
- Depression, anxiety and suicidality are among long-term complications of atopic dermatitis.[1]
- Super-infection
Prognosis
- Atopic dermatitis is a chronic disease with varying subtypes.[11]
- The presence of severe atopic dermatitis and early atopic sensitization is associated with a particularly poor prognosis.[12]
- Mortality is unusual in atopic dermatitis.
References
- ↑ 1.0 1.1 Garmhausen D, Hagemann T, Bieber T, Dimitriou I, Fimmers R, Diepgen T, Novak N (April 2013). "Characterization of different courses of atopic dermatitis in adolescent and adult patients". Allergy. 68 (4): 498–506. doi:10.1111/all.12112. PMID 23452057.
- ↑ Burr ML, Dunstan FD, Hand S, Ingram JR, Jones KP (June 2013). "The natural history of eczema from birth to adult life: a cohort study". Br. J. Dermatol. 168 (6): 1339–42. doi:10.1111/bjd.12216. PMID 23301666.
- ↑ Garmhausen D, Hagemann T, Bieber T, Dimitriou I, Fimmers R, Diepgen T, Novak N (April 2013). "Characterization of different courses of atopic dermatitis in adolescent and adult patients". Allergy. 68 (4): 498–506. doi:10.1111/all.12112. PMID 23452057.
- ↑ Garmhausen D, Hagemann T, Bieber T, Dimitriou I, Fimmers R, Diepgen T, Novak N (April 2013). "Characterization of different courses of atopic dermatitis in adolescent and adult patients". Allergy. 68 (4): 498–506. doi:10.1111/all.12112. PMID 23452057.
- ↑ Spergel JM (August 2010). "From atopic dermatitis to asthma: the atopic march". Ann. Allergy Asthma Immunol. 105 (2): 99–106, quiz 107–9, 117. doi:10.1016/j.anai.2009.10.002. PMID 20674819.
- ↑ Margolis JS, Abuabara K, Bilker W, Hoffstad O, Margolis DJ (June 2014). "Persistence of mild to moderate atopic dermatitis". JAMA Dermatol. 150 (6): 593–600. doi:10.1001/jamadermatol.2013.10271. PMC 4352328. PMID 24696036.
- ↑ Matiz C, Tom WL, Eichenfield LF, Pong A, Friedlander SF (2011). "Children with atopic dermatitis appear less likely to be infected with community acquired methicillin-resistant Staphylococcus aureus: the San Diego experience". Pediatr Dermatol. 28 (1): 6–11. doi:10.1111/j.1525-1470.2010.01293.x. PMID 21070347.
- ↑ 8.0 8.1 Ständer, Sonja; Ropper, Allan H. (2021). "Atopic Dermatitis". New England Journal of Medicine. 384 (12): 1136–1143. doi:10.1056/NEJMra2023911. ISSN 0028-4793.
- ↑ Chen JJ, Applebaum DS, Sun GS, Pflugfelder SC (March 2014). "Atopic keratoconjunctivitis: A review". J. Am. Acad. Dermatol. 70 (3): 569–75. doi:10.1016/j.jaad.2013.10.036. PMID 24342754.
- ↑ Pattnaik L, Acharya L (May 2015). "A comprehensive review on vernal keratoconjunctivitis with emphasis on proteomics". Life Sci. 128: 47–54. doi:10.1016/j.lfs.2015.01.040. PMID 25744396.
- ↑ Illi S, von Mutius E, Lau S, Nickel R, Grüber C, Niggemann B, Wahn U (May 2004). "The natural course of atopic dermatitis from birth to age 7 years and the association with asthma". J. Allergy Clin. Immunol. 113 (5): 925–31. doi:10.1016/j.jaci.2004.01.778. PMID 15131576.
- ↑ Illi S, von Mutius E, Lau S, Nickel R, Grüber C, Niggemann B, Wahn U (May 2004). "The natural course of atopic dermatitis from birth to age 7 years and the association with asthma". J. Allergy Clin. Immunol. 113 (5): 925–31. doi:10.1016/j.jaci.2004.01.778. PMID 15131576.