ATOPIC DERMATITIS AS A CLINICAL CHALLENGE

    Atopic dermatitis (AD) is a chronic, inflammatory skin disease which is characterised by rash, pruritus and xerosis.The disease is most prevalent in infants and small children with about 70% of cases presenting before the age of 5.The prevalence of AD has increased two to three times during the past thirty years in industrially developed countries and, today, AD is considered to be a major public health concern.
    AD is a complex, multifactorial disease resulting from interactions between genetic and environmental factors. Although the pathogenesis of AD is not completely clear, it is known that T-helper cells play the central role in it. Its characteristic is predomination of Th2-type response to allergens instead of the Th1 response which is predominant in normal individuals.
    Disease runs a chronic course, with remissions and exacerbations, while clinical presentation varies among patients depending on age and disease severity.
    There is no cure for AD, and an adequate disease control generally involves a combination of preventive measures and an individualised therapeutic approach. The conventional management includes the use of emollients to maintain the proper skin hydratation. Topical corticosteroids are currently the mainstay of treatment to control disease flares. However the use of these agents is limited to intermittent and short-term treatment due to potentially adverse effects, such as skin atrophy. Tacrolimus and pimecrolimus are steroid-free topical immunomodulators, providing safe and effective treatment for moderate to severe AD. Acta Medica Medianae 2005;44(2): 79-85.

    Key words: atopic dermatitis, Th cells, corticosteroids, topical immunomodulators