Clinical Review

Atopic and non-atopic eczema

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7541.584 (Published 09 March 2006) Cite this as: BMJ 2006;332:584
  1. Sara Brown, specialist registrar in dermatolgy1,
  2. Nick J Reynolds, professor of dematology (N.J.Reynolds@ncl.ac.uk)1
  1. 1 Department of Dermatology, Royal Victoria Infirmary, and Dermatological Sciences, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH
  1. Correspondence to: N J Reynolds, head, School of Clinical and Laboratory Sciences, Medical School, Newcastle upon Tyne NE2 4HH

    Introduction

    Atopic eczema is a chronic, relapsing, inflammatory skin condition associated with epidermal barrier dysfunction. This article provides a summary of current knowledge on eczema and its management.

    Sources and selection criteria

    We used the following sources of information to write this review:

    • PubMed search using the key words “atopic eczema”, “atopic dermatitis”, “incidence”, “genetics”, “pathogenesis”, “treatment”, and “management”. We gave preference to original articles published in the past three years and recent review articles published in high impact journals

    • Search of the following Cochrane Library databases: Cochrane Database of Systemic Reviews; Database of Abstracts and Reviews of Effectiveness; Cochrane Central Register of Controlled Trials

    • Personal archive of references.

    How do we define atopic eczema?

    Atopic eczema and atopic dermatitis are terms that have been used synonymously (for a clinical definition see box), but a review committee by the World Allergy Organisation has published its recommended terminology (see fig 1).1

    Fig 1

    Subgroups of dermatitis. Some patients may have a combination of subgroup types

    Eczema is subdivided into atopic and non-atopic eczema because a proportion of patients exhibit eczema without atopic features. Children with atopic eczema are more likely than those with non-atopic eczema to develop asthma later in life, and their eczema more often persists into adulthood. However, atopic and non-atopic eczema have not been shown to respond differently to treatment, and patients with non-atopic eczema may subsequently develop atopic features.

    Summary points

    Atopic eczema is an itchy inflammatory skin condition with associated epidermal barrier dysfunction

    The prevalence of atopic eczema seems to be rising, but the factors responsible for this rise are not fully understood

    The pathophysiology of eczema involves systemic as well as cutaneous immune and epidermal dysfunction

    Eczema is a complex trait with significant genetic and environmental influences

    Emollients and topical steroids are the mainstay of treatment for mild to moderate eczema; moderate to severe eczema may require the …

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