Dermatology
Atopic Dermatitis (Eczema)
아토피 피부염
Chronic relapsing pruritic eczematous condition with atopic background
- How common
- Children 15–20%, adults 5%
- Typical age
- Onset in infancy
What is it?
Skin-barrier defect (filaggrin mutation) plus Th2-skewed immunity drive the itch–scratch cycle.
Commonly affected: Infants: face/extensors; older: flexures
How it develops
- Barrier defectFilaggrin mutation weakens epidermal barrier
- TEWLDryness and fissuring from water loss
- Th2 inflammationIL-4, IL-13 elevate IgE and eosinophils
- Itch-scratch cycleScratching damages barrier → more itch
Symptoms
- Severe pruritusWorse at night, disrupts sleep
- XerosisRough, scaly
- Eczematous rashErythema, oozing, crusting
- LichenificationSkin thickening from chronic scratching
- Secondary infectionS. aureus colonization common
How it is examined
- Hanifin-Rajka criteria≥3 major + ≥3 minor features
- Atopic triadCoexisting asthma, rhinitis
- SCORAD scoringExtent, intensity, symptom score
Imaging
Clinical diagnosis; imaging not needed.
- Clinical diagnosis
Allergy testing (specific IgE, prick test) if needed.
- Elevated specific IgE
Non-surgical care
- Liberal emollients≥2x/day, immediately after bath
- Topical corticosteroidsMild on face, mid-potency on body
- Topical calcineurin inhibitorsTacrolimus/pimecrolimus (face/long term)
- AntihistaminesSedating (e.g., hydroxyzine) for sleep
- Trigger avoidanceAvoid soaps, wool, hot water, allergens
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Severe/refractory (systemic therapy)
Procedures that may be discussed
- Dupilumab (IL-4Rα mAb)
- Cyclosporine
- Phototherapy (NB-UVB)
Outlook
Over 60% improve by adolescence.