Guidelines on the Management of Atopic Dermatitis ... - Dermatology

Breastfeeding
Allergen exposure:
- House dust mite
- Super-antigen
- Type IV allergens
Irritant exposure:
- Climate
- Hard water
- Clothing
- Occlusive wraps
- Clothes softeners
Bath additives:
- Emollients
- Antiseptics
- Salt
Pollution:
- Urbanisation
- Smoking
- Solvents
Co-morbidities:
- HIV
- BMI
- Smoking
- Psychosocial stress
- Malaria
Some evidence for decreased risk in breastfed
infants with a family history of atopic dermatitis
Decreased exposure/load – no effect prevention
but may have an effect on control in severe cases
Staphylococcal control – no effect control
Contact dermatitis – increased association
Increased risk in cooler climates
Unclear risk in climate extremes
Hard water – no effect if calcium carbonate
removed
Disease aggravation by fibre roughness
Disease aggravation by heavy textiles
Silk clothing – no clear evidence for role in control
Wet or dry – no clear evidence for role in control
No clear evidence for role in control
No clear evidence for role in control
No clear evidence for role in control
No clear evidence for role in control
Increased risk with urbanisation
Increased risk in adults linked to lifetime exposure
Increased risk in established dermatitis
No increased risk
Increased risk in prevention and dermatitis control
Increased risk in adults linked to lifetime exposure
Increased risk in prevention (episodes in early life)
and dermatitis control
Increased risk in Africa
* Possible surrogate markers of urbanisation and increased socio-economic status.
30, 39, 40,
58, 59
32, 35, 36,
38
35, 36, 38,
60
61, 62
21
21, 36
28, 63
35
35
38, 64
38, 65
35
38, 66
35, 36, 38,
60
35
21, 31
67
31
68
24
67
36, 37, 69
17
References
1. Cork MJ, Robinson DA, Vasilopoulos Y et al. New perspectives on epidermal barrier
dysfunction in atopic dermatitis: Gene-environment interactions. J Allergy Clin Immunol
2006;118:3-21
2. Wolf R, Wolf D. Abnormal epidermal barrier in the pathogenesis of atopic dermatitis. Clinics in
Dermatol 2012;30:329-34
3. Irvine AD, Irwin McLean WH, Leung DYM. Filaggrin mutations associated with skin and allergic
disease. N Engl J Med 2011;365:1315-27
4. Cork MJ, Danby SG, Vasilopoulos Y et al. Epidermal barrier dysfunction in atopic dermatitis. J
Invest Dermatol 2009;129:1892-908
5. Rodriquez E, Baurecht H, Herberich E et al. Meta-analysis of filaggrin polymorphisms in
dermatitis and asthma: robust risk factors in atopic disease. J Allergy Clin Immunol
2009;123:1361-70
6. Van den Oord RA, Sheikh A. Filaggrin gene defects and risk of developing allergic sensitisation
and allergic disorders: a systematic review and meta-analysis. Br Med J 2009;339:b2433
7. Baurecht H, Irvine AD, Novak N et al. Towards a major risk factor for atopic dermatitis: metaanalyses
of filiggrin polymorphism data. J allergy Clin Immunol 2007;120:1406-12
8. Hudson. Skin barrier function and allergic risk. Nature Genetics 2006;38:399-400