SEVERE ATOPIC DERMATITIS/ECZEMA A - REVIEW OF THE LITERATURE

Severe atonic dermatitis/eczema (SADE) is an uncommon and potentially debilitating condition with the tendency to follow a persistent course under certain circumstances. Confirmation of the diagnosis and assessment of the extent of impairment in everyday activities and psychosocial functioning is essential. Surveillance is required to ensure early diagnosis and optimal control of comorbid atonic manifestations including food allergies, allergic rhinitis and asthma. Early, aggressive intervention in childhood SADE (e.g. restoration of the skin barrier, reduction of allergen penetration and sensitisation) may prevent progression of the 'atonic march' and the consequential development of cornorbid disease. Complications of SADE may be severe, such as bacterial and viral superinfection, erythroderma, sight-threatening ophthalmological disease, growth retardation, adrenal insufficiency and substantial psychological distress. A stepwise approach to management is essential to ensure that all avenues are explored prior to initiation of potentially harmful therapeutic regimens. Exacerbating factors should be actively excluded (e.g non-compliance, use of unproven complementary remedies, secondary infection, hypersensitivity reactions to topical treatments, etc.). Active management (possibly including phototherapy or systemic immunomodulators) may be required to establish control, but may induce substantial side-effects. Patients and their families should be included as well-informed members of the therapeutic alliance, with the aim of accomplishing long-term favourable outcomes in physical as well as psychosocial dimensions.