Dermatology

Atopic eczema

Atopic eczema is a chronic, relapsing, intensely itchy inflammatory skin disorder in which epidermal barrier dysfunction and immune dysregulation reinforce each other; management combines daily skin care, prompt anti-inflammatory treatment, infection recognition and escalation according to severity and life impact.

Definition

Atopic eczema, also called atopic dermatitis, is a chronic, relapsing, pruritic inflammatory skin disorder characterised by interacting epidermal barrier dysfunction and immune dysregulation, with age-dependent morphology and substantial potential effects on sleep and quality of life.

First principles

Barrier dysfunction and inflammation form a two-way cycle

The stratum corneum limits water loss and entry of irritants, allergens and microbes. In atopic eczema, genetic susceptibility, lipid and protein abnormalities, environmental exposures and immune signalling can all weaken this barrier. Barrier injury promotes inflammation, and inflammation further disrupts barrier proteins and lipids, so neither a purely structural nor a purely immune explanation is sufficient.

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