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