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Atopic dermatitis (AD) or atopic eczema is a chronic inflammatory skin condition with a course that consists of flare-ups and remissions and which affects between 10 and 20% of children and between 2 and 3% of adults in Europe. The increase in its frequency in countries that are becoming more developed suggests that environmental factors play a major role in the pathophysiology of the disease.
The onset is often in infancy, with children being the main group affected, although it sometimes persists into adulthood. It entails dry skin, as well as pruritus that leads to difficulties with sleep that seriously compromise the quality of patients’ lives and that of their families.
Management of AD in children may be undertaken by a combination of general practitioners, paediatricians, allergy specialists, and dermatologists depending on how serious the disease is and the child’s age. In spite of recent and specific national and international recommendations, the approach to managing AD varies from one doctor to another and a lack of consistency in the views of healthcare professionals (including pharmacists) complicates the management of AD.
The prevalence of childhood AD in Western Europe is on the increase, and is estimated at 10 to 15%. In spite of the absence of recent epidemiological studies in France it is estimated to affect around 15% of children under the age of two.
THE HYGIENE HYPOTHESIS AND ENVIRONMENTAL FACTORS
The increased prevalence of this illness in Europe and in newly industrialised countries suggests that environmental factors, in particular a decreased exposure to infectious agents, play a major role in the pathophysiology of the disease, even though these agents have not been clearly identified.
The “hygiene hypothesis”, put forward in the late 1980s, suggested that a higher exposure to a variety of infections early on in life, encouraged by close proximity with large numbers of people (collective childcare or large families), could offer protection from the risk of developing some atopic diseases such as asthma .
More recent studies have provided a fresh perspective on the “hygiene hypothesis”: recent studies confirm that the “western urban” lifestyle does entail an increased risk of developing atopic diseases when compared to a “rural” type lifestyle, especially in genetically homogenous and geographically close populations .
In contrast to prior claims, there is no convincing epidemiological evidence to establish a link with breast-feeding, vaccinations or pollution and the risk of developing eczema.
THE ATOPIC MARCH
The onset of AD is usually in the first year of life and in the majority of cases it regresses spontaneously around the age of five. It can, however, persist into adulthood in around 15% of patients.
Atopy is defined by guidelines from the World Health Organisation (WHO) as a predisposition to an abnormal IgE-mediated immune response to certain environmental antigens defined as allergens.
AD is concomitant with asthma in 30% of cases. A number of concomitant manifestations of atopy in a single patient is a classic presentation but it is not always the case. It has not to date been proven that timely management of the earliest manifestations of atopy leads to a reduced risk of developing subsequent manifestations.
AD is concomitant with asthma in 30% of cases. These manifestations usually appear in the following order: AD, food allergy, asthma, allergic rhinitis and allergic conjunctivitis. This chronological sequence is called the “atopic march”. Early and severe eczema increases the risk of asthma by a factor of three.
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