Atopic dermatitis or atopic eczema is an inflammatory disease characterized by dry skin, itching, red lesions and course more or less chronic and recurrent. It usually begins during childhood and gradually fade with age but may persist or even appear for the first time in adulthood. In atopic dermatitis in infants, lesions are usually more acute and localized on the face and in areas of extension members. After two years, the lesions are becoming more chronic, with thickening of the skin by scratching frequently, preferably by members flexor areas (elbows, knees, wrists, …). There may be lip involvement, worsened in many cases by sucking and constant moisture in the area.

Atopic dermatitis has become a public health problem in developed countries, affecting up to 20-30% of children with a higher prevalence in urban areas and in higher social classes. Many authors have supported the “hygiene hypothesis” which enacts that the reduced exposure of children to germs and allergens that occurs in developed areas hinders the proper maturation of the immune system and contributes to allergies. Moreover, today’s society, sometimes not conducive enough the breastfed infant whose beneficial effects are indisputable. Thus, exclusive breast feeding during the first three months of life is associated with a lower incidence of atopic dermatitis. However, children who are sent to day care after a certain age, have a lower incidence of atopic dermatitis.

The frequent association of atopic dermatitis to asthma and allergic rhinitis is caused by genetic alterations that correlate with immunological imbalances. This would explain, for example, that allergy to egg protein is associated with greater severity and duration of atopic dermatitis.

On the origin and maintenance of atopic eczema seems to be a vicious circle of itching and mechanical damage by scratching induce the production of proinflammatory molecules which in turn favor the eczema and itching. Hence the importance of trying to prevent scratching of the skin, although this is difficult, especially in children.

In the topical treatment of atopic dermatitis are used steroids and antibiotics as well as calcineurin inhibitors (tacrolimus and pimecrolimus). A few years ago, the FDA issued a warning regarding the use of tacrolimus and pimecrolimus, in terms of a possible lack of long-term security and a possible connection with the development of lymphoma, which has not been shown in recent studies. Today, it advocates the use of these creams, together with milk and body moisturizers, as maintenance therapy, once improved the outbreak, for a longer time to clinical remission and reduce the total dose of topical corticosteroids. In severe cases of atopic dermatitis may require oral treatment under medical supervision, steroids or cyclosporin. Good to know that there is little evidence to support the use of oral antihistamines in atopic dermatitis, although the use of sedating antihistamines may help sleep at night.