Atopic eczema: how to tackle the most common atopic symptom.


Wahn U, Staab D, Nilsson L




Pediatr Allergy Immunol


The disease management of atopic eczema includes topical and systemic treatments as well as the control of allergic and non-allergic trigger factors. The basis for topical treatment is the regular use of emollients. In addition, anti-inflammatory treatment with -- preferably mild -- topical steroids is the treatment of choice. At least-one third of the children with atopic eczema during the first years suffer from clinically relevant food allergy requiring elimination diets for at least one or two years. The most common cause of superinfection is Staphylococcus aureus. Recent data suggests that it may induce purulent superinfection as well as enhance the inflammatory process by superantigen mediated T-cell activation. Also, a number of alternative treatment strategies have been investigated during the last decade: the use of gamma-linoleic acid has been shown to be of limited benefit, while studies on interferon-gamma and on high-dose intravenous gamma-globulin are still anecdotal. The long-term effectiveness of disease management in atopic eczema depends largely on the understanding of the disease process as well as on the compliance of the parents. Thus, coping with the problem will be easier if the patient or the parents have been educated in understanding the pathogenesis, the role of trigger factors, the possibilities of prevention and the different treatment strategies.