Atopic eczema

Atopic eczema (AE) affects 15–30% of children and up to 10% of adults. Null mutations in the filaggrin gene are associated with AE. Filaggrin plays a key role in epidermal barrier function and the resultant barrier dysfunction may allow increased exposure to irritants and allergens. Having a child with atopic eczema can be difficult and can affect many aspects of family life.Patient and parent education is an important aspect of the management of AE. Emollients applied frequently, even when the eczema is under control, can help prevent exacerbations. Appropriate use of topical corticosteroids, used at various strengths depending on body site and age of the patient, is still a mainstay of treatment. Topical calcineurin inhibitors can also be useful immunomodulators, particularly in children. Intermittent use of sedative antihistamines and oral or topical antibiotics may be required, and garments and bandages can be very helpful to decrease scratching, especially in children.In a secondary care setting, it is often more effective to gain control of the disease using a combination of treatments and then to maintain control once achieved. Second-line treatments with narrowband ultraviolet B or immunosuppressive drugs may be required for chronic severe atopic eczema.