Scientific understanding of atopic dermatitis

  Atopic dermatitis (AD, once called atopic dermatitis) is a chronic, recurrent, pruritic, inflammatory skin disease that severely affects the quality of life of patients and their family members. It belongs to the same category of allergic diseases (commonly known as allergic diseases) as asthma and allergic rhinitis. According to statistics, more than 2.3 million adolescents in China are currently affected by atopic dermatitis, and some of these patients can extend their disease into adulthood. Many patients are often diagnosed with “eczema” and are not treated effectively. The exact pathogenesis of atopic dermatitis is not known. It is believed that the genetic background and/or environmental factors cause skin barrier dysfunction or direct dysregulation of the body’s immune response, resulting in a variable or non-variable inflammatory response. Skin barrier dysfunction creates conditions for local sensitization of allergens or microbial colonization, which is an important basis for triggering or aggravating skin inflammation.  The clinical manifestations of atopic dermatitis are diverse, with the most basic features being a slow-onset, recurrent-onset, pruritic rash with certain age-stage characteristics. Atopic dermatitis is currently divided into three stages: infancy, childhood, and adulthood. Infantile stage (1 month to 2 years old): it is characterized by infantile eczema, with exudative and dry lesions, mostly on both cheeks, forehead and scalp. Childhood (2-12 years): Mostly evolving from infancy or not, the lesions are of eczema and itchy rash type, mostly occurring in the elbow fossa, N fossa and lower leg extensions. Adolescent adult stage (> 12 years old): lesions are similar to those of childhood, mostly limited dry dermatitis damage, mainly occurring in the elbow fossa, rouge fossa and anterior neck, but also on the face and back of the hands.  The current diagnostic criteria are: pruritus (including scratching), plus 3 or more of the following 5 criteria: 1. history of flexural dermatitis eczema, including elbow fossa, N fossa, anterior ankle, and neck (including cheek in children under 10 years of age); 2. personal history of asthma or allergic rhinitis (or history of atopic disease in first-degree relatives of children under 4 years of age); 3. recent history of generalized dry skin; 4. History of generalized dry skin in recent years; 4. Eczema visible on the flexors (or on the cheeks/forehead and extremities in children under 4 years of age); 5. Onset before 2 years of age (for patients over 4 years of age).  Because atopic dermatitis has a long duration and is prone to recurrence, the principles of its treatment are based on restoring the normal barrier function of the skin, finding and removing triggering and/or aggravating factors, and reducing or relieving symptoms as the main objectives, and correcting dry skin, of which protecting the barrier function of the skin and stopping itching are key measures in the treatment of atopic dermatitis. When administering the necessary medication, it is important to provide health education to patients and/or family members so that they have a clear understanding of the disease, treatment methods and processes, and pay attention to various precautions in their lives, such as avoiding or reducing exposure to triggering factors as much as possible; understanding the importance and use of adjuvant treatments such as emollients; avoiding or reducing the need to seek so-called “potent ” therapy; understand the effects and adverse effects of relevant drugs, understand the benefits and risks of various treatments, and cooperate with doctors to obtain the best possible results.  There are several aspects of daily life that need attention: firstly, daily clothing should preferably be cotton and loose, secondly, use emollients after bathing for sure, do not use water that is too hot and do not use too strong alkaline soap. In addition, some places that may cause allergies should be less, do not keep pets at home, cats and dogs may be allergens, and diet needs to be noted, such as spicy food may aggravate the irritation.  In the process of AD treatment, the doctor should evaluate the patient’s medical history, disease duration, severity and extent of involvement, and give the corresponding “comprehensive treatment” (mainly referring to the selection and combination of different drugs, the timing and manner of use, and the adjustment of drugs when the disease recurs) according to different conditions. The use of effective and safe emollients more than twice a day is currently considered important for long-term remission. Since this disease is chronic and requires long-term treatment, doctor-patient cooperation is very important to obtain good results.