Special paper
Atopic dermatitis – contemporary view on pathomechanism and management. Position statement of the Polish Dermatological Society specialists

The present publication includes contemporary data concerning aetiopathogenesis, clinical manifestation and management of atopic dermatitis. In spite of systematically broadened research methods, the pathomechanism of the disease has not yet been fully elucidated. An important role in pathophysiology of atopic dermatitis seems to be associated with genetically related disturbance of both structure and function of the epidermal barrier, disturbance of innate and adaptive immunity, inflammation, infectious factors, and the surrounding environment (airborne allergens, and in younger age groups also food allergens). It is also well known that IgE antibodies directed against autoantigens may be the cause of the immediate reaction, but also may stimulate dendritic cells. There are two clinical phases of the disease: eczematous type (typical for infants and young children) and lichenoid type (observed in children, youngsters and adults). Severity of atopic dermatitis may be evaluated with various indicators (EASI, W-AZS, SCORAD, POEM). It is worth emphasizing that W-AZS is precise and useful in scientific research, in the process of comparison between patient groups and in evaluation of individual course of the disease at different time points. Management of atopic dermatitis patients includes three main elements: prophylaxis (primary, secondary and additional), proper care of atopic skin, and local and systemic treatment. Proper and systematic skin care allows one to rebuild and maintain normal functioning of the skin barrier. Emollients belong to two generations: older (creams, lotions, ointments) and contemporary (crelo, lipocream and nano cream). Emollients are characterized by limited action (maximum 6 hours), so they should be applied at least three times a day. Local anti-inflammatory treatment of atopic dermatitis consists of glucocorticosteroids and topical calcineurin inhibitors. Depending on particular indications, local antimicrobials (antibacterial, antifungal) are also in use. In spite of earlier reports, recent widely conducted research confirms no association between the use of topical calcineurin inhibitors and cancer. What is more, promising data have been published regarding “proactive therapy”, allowing one to control the disease with the minimal use of anti-inflammatory medication and also to prevent flares. Systemic therapy of atopic dermatitis includes antihistamine and immunosuppressive drugs and in some cases antibiotics and antiviral medications. The only possibility of causative treatment in atopic disease is specific immunotherapy. Moreover, because of the significant role of the complex immunological pathomechanism of the disease also biological therapy seems to be an important alternative, particularly because it gives a possibility to treat more specifically and less toxically in comparison with other groups of preparations.