Atopic Dermatitis: Pathophysiology Driving Management Decisions - Episode 1

Overview of Atopic Dermatitis and Eczema

Peter A. Lio, MD, gives a brief overview of atopic dermatitis and eczema, describing the differences between them and common misconceptions

Peter A. Lio, MD: Hello and welcome to this Dermatology Times® Viewpoints program titled “Atopic Dermatitis: Pathophysiology Driving Management Decisions.” I’m Dr Peter Lio, a clinical assistant professor of dermatology and pediatrics at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Our discussion today is going to focus on diagnosis, treatment options, and drugs in development to treat atopic dermatitis. Joining me in this discussion are: Dr Linda Stein Gold, director of dermatology clinical research at Henry Ford Health System in Detroit, Michigan; and Dr Emma Guttman, director of the Center for Excellence in Eczema, and director of the Laboratory of Inflammatory Skin Diseases at the Icahn School of Medicine at Mount Sinai Medical Center in New York.

Welcome, let’s begin.

Let’s start with the idea of what is atopic dermatitis? Is this term interchangeable with the frequently heard label, eczema? It’s fascinating because we think of eczema as being a bit more of a clinical descriptive term. It refers to things that are scaly and red, and often oozy and weepy, and it includes some other entities such as contact dermatitis and even seborrheic dermatitis, depending on how you like to slice it up.

Atopic dermatitis is the key eczematous eruption that we talk about. Because it’s such an important one, we often use those terms synonymously. Atopic dermatitis may be a bit more narrowly defined, and clinically, it’s an entity that is different in part because of the group that it affects. It trends toward younger patients, and we know that most of the patients develop it in the first 5 years of life. It also tends to be chronic and remitting as opposed to some other entities that can be much more focused in time.

The typical age of onset is under 5 years of age, but it’s important that we see it in all age groups. This includes something that, when I trained, was not nearly as commonly considered: adult onset atopic dermatitis has been a real entity. Emma, Linda, what are your thoughts about when we see this diagnosis and what types of patients might be affected?

Emma Guttman, MD, PhD: I agree with everything you said. We sometimes have patients who, in the beginning, swear to you that their disease started in adulthood. You then start asking them, and they say, “You’re right. When I was little, my mother says that I did have some dry skin, and I also have asthma. People in my family also have asthma and eczema.” When you make that determination, it’s important to ask these questions and ascertain the atopic morbidity in the patient and in the family to really understand whether it started later in life and whether the patient has some atopic comorbidities. These patients will typically have some atopic morbidities if it starts later in life, or we will see that in the family.

Linda Stein Gold, MD: I agree. The more we understand, the more we realize that this isn’t 1 homogenous group. In fact, even just looking at the pediatric population, there are differences in when it starts, how long it persists, and the associated comorbidities. The more we understand, the more complicated it becomes