Atopic Eczema: Understanding Causes, Symptoms, and Effective Treatments

Atopic dermatitis (eczema) is a chronic, relapsing inflammatory skin disease with barrier dysfunction and immune dysregulation.

Pathophysiology

• Genetic: FLG (filaggrin) mutations → impaired barrier.
• Immune: Th2/Th22/Th17 skewing, IgE elevation.
• Environmental: allergens, irritants, microbes (S. aureus), climate, stress.

Symptoms

• Intense pruritus (hallmark)
• Erythematous, scaly, lichenified patches
• Flexural distribution (antecubital, popliteal, neck)
• Xerosis, fissures, excoriations
• Sleep disturbance, quality-of-life impact

Treatment Ladder

1. Baseline: Emollients 2×/day, gentle cleansers, trigger avoidance.
2. Mild: Low-potency topical corticosteroids (TCS) or topical calcineurin inhibitors (TCI: tacrolimus, pimecrolimus).
3. Moderate: Mid-potency TCS; crisaborole (PDE4 inhibitor); ruxolitinib (JAK inhibitor) cream.
4. Severe: Systemic: dupilumab (IL-4Rα), tralokinumab (IL-13), upadacitinib/abrocitinib (JAKi), phototherapy (NB-UVB), conventional immunosuppressants (cyclosporine, methotrexate, azathioprine).

Key Principles

• Proactive maintenance (weekend TCS/TCI) prevents flares.
• Treat infection (S. aureus) if honey-crusted.
• Address psychosocial impact.

Individualized, stepwise approach with regular follow-up.