Introduction

Atopic eczema is a common condition that affects more than one in ten children in developed countries, and the incidence is increasing. There are probably several reasons for this, including higher exposure to air pollution, smaller families with less exposure to infections, more pets, higher maternal age, and a wider range of foods. There is clearly also an important hereditary component to atopic eczema. This is complex because not all affected children are atopic, though the genes implicated in atopy are likely to be involved, together with others as yet unknown. Atopic eczema usually presents during the first year of life, and when it is severe it is extremely disabling. It may also cause major psychological problems. Most affected children are also allergic to house dust mite, and this is probably a major cause of exacerbation of the condition. Probably less than 10% overall have IgE mediated food allergy, but some have late phase reactions with positive results on patch tests to foods.

Methods

We searched Medline for entries on atopic eczema and atopic dermatitis in children and adults. We also relied on our personal experience in treating children with atopic eczema over the past 30 years.

Clinical features

Atopic eczema is usually the first manifestation of atopy and may coincide with food allergy; asthma often follows, then allergic rhinitis (fig 1).

There is a …