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The therapeutic concept of “patient management” in atopic eczema

Atopic eczema (or atopic dermatitis) is a chronic pruritic inflammatory skin disorder characterized by a typical age-related distribution and skin morphology (1). Atopy can be defined as familial hypersensitivity of skin and mucous membranes to environmental substances, associated with increased IgE production and/or altered nonspecific reactivity (2). Over the last decades, the incidence of atopic eczema has dramatically increased worldwide (3). Atopic eczema for which a multifactorially determined polygenic background is discussed (4, 5 ) is one of the most common skin diseases, usually starting in childhood. While some affected people outgrow their eczema, it may last for decades in others, and it may be complicated by the development of respiratory atopic diseases (6, 7). The health systems of all countries are burdened with the heavy economic load of direct and indirect costs of treatment and social morbidity (8). Although the pathogenesis of atopic eczema is not known, knowledge of components of immune and inflammatory responses in patients with atopic eczema has increased over the last decade (9, 10). However, there is still a wide gap between experimental progress and everyday clinical practice. There is much frustration among patients, parents, and doctors with regard to therapeutic approaches. Here, we describe our concept of “patient management” for atopic eczema, integrating aspects of diagnosis, therapy, and prevention.