Atopic eczema/atopic dermatitis

Published on September 29, 2016   49 min
0:00
Hello, I'm Michael Ardern-Jones, Associate Professor of Dermatology and Clinical Consultant Dermatologist at the University of Southampton. And today I'm going to talk to you about Atopic Eczema. In this title slide reminds me to have emphasize that the term Atopic Eczema is synonymous with the Atopic Dermatitis. The two are completely interchangeable and if I use atopic eczema throughout subsequent slides then you could also replace that with atopic dermatitis.
0:28
Atopic eczema is one of variety of different eczemas and I've listed here some different variants of eczema which I'm not going to focus on this presentation, instead I'm going to talk about atopic eczema which is characterized by an itchy, chronically relapsing, inflammatory skin condition that is much more prominent in childhood than in adulthood.
0:50
I'm going to talk to you about epidemiology, diagnostic criteria and clinical features, co-morbidities, genetics, immunology, allergy and current management, and then I'm going to move on to future management of the disease.
1:05
Epidemiology of atopic dermatitis has been studied for a long time and one of the most important studies has been the international study on asthma and allergy in childhood which looked at the prevalence of allergies, including eczema, in 106 countries. And this study was able to undertake a global prevalence measurement of atopic eczema and you can see here that although there was a wide range of prevalence in atopic eczema in different countries that actually this is a common disease in children. The UK as you can see it lies at the upper end of the prevalence range and this is reflected in the health demands in our country. A recent systematic review of prevalence studies has shown that lifetime prevalence of atopic eczema is approximately 20% in Western countries and that this is in fact increasing year on year. A recent study looked at the prevalence in different age groups of children and you can see here how majority of atopic eczema arises in the first year of life. Adults atopic eczema is far less common and affects one to three percent of adults.
2:14
Atopic eczema is important and it's been shown in a variety of different studies the impact on quality of life and one of the ways to represent that is the impact on ability to work. You can see here how there's a significantly increased prevalence of complications that result in a reduced capacity to work in patients with atopic eczema as opposed to patients without atopic eczema.
2:39
Atopic eczema also has a major impact on mental health and this secondarily impacts quality of life, as measured here by the mental component summary scores. And you can see how eczema compares to a variety of other different important systemic diseases in terms of impacting mental health, and the lower the score represents the worst patient outcome.
3:02
What happens in individuals who have a atopic eczema? One useful epidemiological report looked at a cohort of children over seven years and each of these black dots represents one percent of the population studied. And you can see here that some children go on and have persistent disease, others seem to clear their disease in early life and others seem to clear their disease and then it recurs then it clears then it recurs and then it clears again. And so, this is Intermittent disease. There's already obviously a variety of different patterns of atopic eczema in terms of how long it affects the individual.
3:44
I'm going to talk now about the Diagnostic criteria and clinical features.
3:49
One of the most important diagnostic criteria were the Hanifin Rajka criteria that were initially published in 1980 and modified by Hanifin in 1992. And you can see here they represent a variety of different clinical aspects to the disease that are described and enumerated to make the diagnosis of atopic eczema. The major criteria of which three are required are pruritus or itch, visible eczema, a pattern of disease that is typical of eczema with chronic or relapsing disease, and a personal family history of atopy. Minor criteria of which only four are required are quite extensive in the number of different clinical aspects that are listed. These criteria are very useful for undertaking epidemiological studies of atopic eczema but they are challenged by the fact that there are so many different clinical aspects to the scoring, and that makes it uncertain as to the stability of the clinical phenotype within different studies.
4:49
As you already have seen from these previous criteria the issue of atopy is also raised in the diagnostic criteria. Atopic eczema is a misnomer really because atopic eczema individuals can have a normal total IgE, they don't usually have a specific allergic reaction, and there's a large proportion of individuals with atopic eczema who have no evidence of atopy. And so really the atopic element is a questionable component to the disease.
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Atopic eczema/atopic dermatitis

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