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{{Atopic dermatitis}}
{{Atopic dermatitis}}
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==Overview==
==Overview==
Atopic dermatitis is a multifactorial, chronic inflammatory skin disease as a result of interactions between various genetic, immune and environmental factors.
Atopic dermatitis is a multifactorial, [[chronic]] inflammatory skin disease as a result of interactions between various [[Genetics|genetic]], [[immune]], and environmental factors. The most important [[risk factor]] for the development of atopic dermatitis is a [[family history]] or personal history of [[atopy]] including [[asthma]], [[allergic rhinitis]], [[food allergy]].


==Risk Factors==
==Risk Factors==
The most potent risk factor in the development of atopic dermatitis is family history of atopy and personal history of atopy.
The most potent [[risk factor]] in the development of atopic dermatitis is a [[family history]] or personal history of [[atopy]].
===Common Risk Factors===
===Common Risk Factors===
*Common risk factors in the development of atopic dermatitis include:
 
**Family history of atopic dermatitis or other atopy<ref name="pmid19785611">{{cite journal |vauthors=Wen HJ, Chen PC, Chiang TL, Lin SJ, Chuang YL, Guo YL |title=Predicting risk for early infantile atopic dermatitis by hereditary and environmental factors |journal=Br. J. Dermatol. |volume=161 |issue=5 |pages=1166–72 |date=November 2009 |pmid=19785611 |doi=10.1111/j.1365-2133.2009.09412.x |url=}}</ref>
*Common [[Risk factor|risk factors]] in the development of atopic dermatitis include:
***70% of atopic dermatitis  patients have a positive family history of atopic diseases
**Family history of atopic dermatitis or other [[atopy]]<ref name="pmid19785611">{{cite journal |vauthors=Wen HJ, Chen PC, Chiang TL, Lin SJ, Chuang YL, Guo YL |title=Predicting risk for early infantile atopic dermatitis by hereditary and environmental factors |journal=Br. J. Dermatol. |volume=161 |issue=5 |pages=1166–72 |date=November 2009 |pmid=19785611 |doi=10.1111/j.1365-2133.2009.09412.x |url=}}</ref>
***Risk of developing atopic dermatitis is 2- to 3-fold higher in children with 1 atopic parent<ref name="pmid2353830">{{cite journal |vauthors=Küster W, Petersen M, Christophers E, Goos M, Sterry W |title=A family study of atopic dermatitis. Clinical and genetic characteristics of 188 patients and 2,151 family members |journal=Arch. Dermatol. Res. |volume=282 |issue=2 |pages=98–102 |date=1990 |pmid=2353830 |doi= |url=}}</ref>
***70% of atopic dermatitis  [[patients]] have a positive family history of atopic diseases
***Risk of developing atopic dermatitis is 3- to 5-fold higher in children with both atopic parents.<ref name="pmid23538302">{{cite journal |vauthors=Küster W, Petersen M, Christophers E, Goos M, Sterry W |title=A family study of atopic dermatitis. Clinical and genetic characteristics of 188 patients and 2,151 family members |journal=Arch. Dermatol. Res. |volume=282 |issue=2 |pages=98–102 |date=1990 |pmid=2353830 |doi= |url=}}</ref>
***Risk of developing atopic dermatitis is 2- to 3-fold higher in children with 1 atopic parent <ref name="pmid2353830">{{cite journal |vauthors=Küster W, Petersen M, Christophers E, Goos M, Sterry W |title=A family study of atopic dermatitis. Clinical and genetic characteristics of 188 patients and 2,151 family members |journal=Arch. Dermatol. Res. |volume=282 |issue=2 |pages=98–102 |date=1990 |pmid=2353830 |doi= |url=}}</ref>
**loss of function mutations in the ''filaggrin'' (''FLG'') gene<ref name="pmid16550169">{{cite journal |vauthors=Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, Lee SP, Goudie DR, Sandilands A, Campbell LE, Smith FJ, O'Regan GM, Watson RM, Cecil JE, Bale SJ, Compton JG, DiGiovanna JJ, Fleckman P, Lewis-Jones S, Arseculeratne G, Sergeant A, Munro CS, El Houate B, McElreavey K, Halkjaer LB, Bisgaard H, Mukhopadhyay S, McLean WH |title=Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis |journal=Nat. Genet. |volume=38 |issue=4 |pages=441–6 |date=April 2006 |pmid=16550169 |doi=10.1038/ng1767 |url=}}</ref>
***Risk of developing atopic dermatitis is 3- to 5-fold higher in children with both atopic parents <ref name="pmid23538302">{{cite journal |vauthors=Küster W, Petersen M, Christophers E, Goos M, Sterry W |title=A family study of atopic dermatitis. Clinical and genetic characteristics of 188 patients and 2,151 family members |journal=Arch. Dermatol. Res. |volume=282 |issue=2 |pages=98–102 |date=1990 |pmid=2353830 |doi= |url=}}</ref>
***risk for earlier-onset atopic dermatitis
**Loss of function [[mutations]] in the ''[[filaggrin]]'' ([[Filaggrin|''FLG'') gene]]<ref name="pmid16550169">{{cite journal |vauthors=Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, Lee SP, Goudie DR, Sandilands A, Campbell LE, Smith FJ, O'Regan GM, Watson RM, Cecil JE, Bale SJ, Compton JG, DiGiovanna JJ, Fleckman P, Lewis-Jones S, Arseculeratne G, Sergeant A, Munro CS, El Houate B, McElreavey K, Halkjaer LB, Bisgaard H, Mukhopadhyay S, McLean WH |title=Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis |journal=Nat. Genet. |volume=38 |issue=4 |pages=441–6 |date=April 2006 |pmid=16550169 |doi=10.1038/ng1767 |url=}}</ref>
***Risk for earlier-onset atopic dermatitis
***Risk for severe and persistent atopic dermatitis
***Risk for severe and persistent atopic dermatitis
**Personal history of atopy (Asthma, allergic rhinitis, food allergy)<ref name="pmid20579595">{{cite journal |vauthors=Suh KY |title=Food allergy and atopic dermatitis: separating fact from fiction |journal=Semin Cutan Med Surg |volume=29 |issue=2 |pages=72–8 |date=June 2010 |pmid=20579595 |doi=10.1016/j.sder.2010.03.007 |url=}}</ref>
**Personal history of [[atopy]] ([[asthma]], [[allergic rhinitis]], [[food allergy]]) <ref name="pmid20579595">{{cite journal |vauthors=Suh KY |title=Food allergy and atopic dermatitis: separating fact from fiction |journal=Semin Cutan Med Surg |volume=29 |issue=2 |pages=72–8 |date=June 2010 |pmid=20579595 |doi=10.1016/j.sder.2010.03.007 |url=}}</ref>
** Environmental factors predisposing individuals to the development of atopic dermatitis include:<ref name="pmid23452057">{{cite journal |vauthors=Garmhausen D, Hagemann T, Bieber T, Dimitriou I, Fimmers R, Diepgen T, Novak N |title=Characterization of different courses of atopic dermatitis in adolescent and adult patients |journal=Allergy |volume=68 |issue=4 |pages=498–506 |date=April 2013 |pmid=23452057 |doi=10.1111/all.12112 |url=}}</ref>
***Temperature (colder climates with low [[humidity]])
***Ultraviolet radiation
***Air pollution
***Water hardness
***Household hygiene
===Less Common Risk Factors===


===Less Common Risk Factors===
*Less common [[Risk factor|risk factors]] in the development of atopic dermatitis include:
*Less common risk factors in the development of [disease name] include:
**[[Infections]]
**High domestic water CaCO3 levels in infancy<ref name="pmid27241890">{{cite journal |vauthors=Perkin MR, Craven J, Logan K, Strachan D, Marrs T, Radulovic S, Campbell LE, MacCallum SF, McLean WH, Lack G, Flohr C |title=Association between domestic water hardness, chlorine, and atopic dermatitis risk in early life: A population-based cross-sectional study |journal=J. Allergy Clin. Immunol. |volume=138 |issue=2 |pages=509–16 |date=August 2016 |pmid=27241890 |doi=10.1016/j.jaci.2016.03.031 |url=}}</ref>
***Children who are frequently exposed to [[infections]], carry an increased probability of developing atopic dermatitis and other [[Allergic disorders|allergic diseases]].<ref name="pmid117993642">{{cite journal |vauthors=McKeever TM, Lewis SA, Smith C, Collins J, Heatlie H, Frischer M, Hubbard R |title=Early exposure to infections and antibiotics and the incidence of allergic disease: a birth cohort study with the West Midlands General Practice Research Database |journal=J. Allergy Clin. Immunol. |volume=109 |issue=1 |pages=43–50 |date=January 2002 |pmid=11799364 |doi= |url=}}</ref>
***During [[pregnancy]], exposure to [[antibiotics]] and [[infections]] is a crucial risk factor for the development of [[Atopy|atopic march]] diseases.<ref name="pmid122314922">{{cite journal |vauthors=McKeever TM, Lewis SA, Smith C, Hubbard R |title=The importance of prenatal exposures on the development of allergic disease: a birth cohort study using the West Midlands General Practice Database |journal=Am. J. Respir. Crit. Care Med. |volume=166 |issue=6 |pages=827–32 |date=September 2002 |pmid=12231492 |doi=10.1164/rccm.200202-158OC |url=}}</ref>
**House renovation
***Mothers who have been living in a renovated areas during [[pregnancy]] has increased risk of developing [[atopic diseases]] in the children.<ref name="pmid197856112">{{cite journal |vauthors=Wen HJ, Chen PC, Chiang TL, Lin SJ, Chuang YL, Guo YL |title=Predicting risk for early infantile atopic dermatitis by hereditary and environmental factors |journal=Br. J. Dermatol. |volume=161 |issue=5 |pages=1166–72 |date=November 2009 |pmid=19785611 |doi=10.1111/j.1365-2133.2009.09412.x |url=}}</ref>
**[[Vaccination]]
***Recent published studies has observed a significantly higher risk of [[asthma]] and [[atopic diseases]] in non-vaccinated children vs vaccinated children.<ref name="pmid15853947">{{cite journal |vauthors=Martignon G, Oryszczyn MP, Annesi-Maesano I |title=Does childhood immunization against infectious diseases protect from the development of atopic disease? |journal=Pediatr Allergy Immunol |volume=16 |issue=3 |pages=193–200 |date=May 2005 |pmid=15853947 |doi=10.1111/j.1399-3038.2005.00254.x |url=}}</ref>
**High domestic water [[calcium carbonate]] levels in infancy<ref name="pmid27241890">{{cite journal |vauthors=Perkin MR, Craven J, Logan K, Strachan D, Marrs T, Radulovic S, Campbell LE, MacCallum SF, McLean WH, Lack G, Flohr C |title=Association between domestic water hardness, chlorine, and atopic dermatitis risk in early life: A population-based cross-sectional study |journal=J. Allergy Clin. Immunol. |volume=138 |issue=2 |pages=509–16 |date=August 2016 |pmid=27241890 |doi=10.1016/j.jaci.2016.03.031 |url=}}</ref>
**Higher level of parental education<ref name="pmid20444159">{{cite journal |vauthors=Weber AS, Haidinger G |title=The prevalence of atopic dermatitis in children is influenced by their parents' education: results of two cross-sectional studies conducted in Upper Austria |journal=Pediatr Allergy Immunol |volume=21 |issue=7 |pages=1028–35 |date=November 2010 |pmid=20444159 |doi=10.1111/j.1399-3038.2010.01030.x |url=}}</ref>
**Higher level of parental education<ref name="pmid20444159">{{cite journal |vauthors=Weber AS, Haidinger G |title=The prevalence of atopic dermatitis in children is influenced by their parents' education: results of two cross-sectional studies conducted in Upper Austria |journal=Pediatr Allergy Immunol |volume=21 |issue=7 |pages=1028–35 |date=November 2010 |pmid=20444159 |doi=10.1111/j.1399-3038.2010.01030.x |url=}}</ref>
**Living in urban areas<ref name="pmid20331459">{{cite journal |vauthors=Schram ME, Tedja AM, Spijker R, Bos JD, Williams HC, Spuls PI |title=Is there a rural/urban gradient in the prevalence of eczema? A systematic review |journal=Br. J. Dermatol. |volume=162 |issue=5 |pages=964–73 |date=May 2010 |pmid=20331459 |doi=10.1111/j.1365-2133.2010.09689.x |url=}}</ref>
**Living in urban areas<ref name="pmid20331459">{{cite journal |vauthors=Schram ME, Tedja AM, Spijker R, Bos JD, Williams HC, Spuls PI |title=Is there a rural/urban gradient in the prevalence of eczema? A systematic review |journal=Br. J. Dermatol. |volume=162 |issue=5 |pages=964–73 |date=May 2010 |pmid=20331459 |doi=10.1111/j.1365-2133.2010.09689.x |url=}}</ref>
**Exposure to antibiotics in infancy<ref name="pmid23782060">{{cite journal |vauthors=Tsakok T, McKeever TM, Yeo L, Flohr C |title=Does early life exposure to antibiotics increase the risk of eczema? A systematic review |journal=Br. J. Dermatol. |volume=169 |issue=5 |pages=983–91 |date=November 2013 |pmid=23782060 |doi=10.1111/bjd.12476 |url=}}</ref>
**Exposure to [[antibiotics]] in [[infancy]]<ref name="pmid23782060">{{cite journal |vauthors=Tsakok T, McKeever TM, Yeo L, Flohr C |title=Does early life exposure to antibiotics increase the risk of eczema? A systematic review |journal=Br. J. Dermatol. |volume=169 |issue=5 |pages=983–91 |date=November 2013 |pmid=23782060 |doi=10.1111/bjd.12476 |url=}}</ref>
**Colder climates with low humidity
**Active and passive exposure to tobacco<ref name="pmid27542586">{{cite journal |vauthors=Kantor R, Kim A, Thyssen JP, Silverberg JI |title=Association of atopic dermatitis with smoking: A systematic review and meta-analysis |journal=J. Am. Acad. Dermatol. |volume=75 |issue=6 |pages=1119–1125.e1 |date=December 2016 |pmid=27542586 |pmc=5216172 |doi=10.1016/j.jaad.2016.07.017 |url=}}</ref>
 
**Itching causes scratching which leads to dysfunction of the epidermal skin barrier.
***[[Risk factors]] which aggravate itching include [[sweating]], [[dry skin]], [[emotional stress]],  hot water, and certain foods.
**[[Stress]] can result into increased levels of [[Cortisol|glucocorticosteroids]] in blood, which further leads to dysfunction of skin barrier by affecting the integrity and adhesion of the [[stratum corneum]].<ref name="pmid18606083">{{cite journal |vauthors=Arndt J, Smith N, Tausk F |title=Stress and atopic dermatitis |journal=Curr Allergy Asthma Rep |volume=8 |issue=4 |pages=312–7 |date=July 2008 |pmid=18606083 |doi= |url=}}</ref>


==References==
==References==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD; Shalinder Singh, M.B.B.S.[2]

Overview

Atopic dermatitis is a multifactorial, chronic inflammatory skin disease as a result of interactions between various genetic, immune, and environmental factors. The most important risk factor for the development of atopic dermatitis is a family history or personal history of atopy including asthma, allergic rhinitis, food allergy.

Risk Factors

The most potent risk factor in the development of atopic dermatitis is a family history or personal history of atopy.

Common Risk Factors

  • Common risk factors in the development of atopic dermatitis include:
    • Family history of atopic dermatitis or other atopy[1]
      • 70% of atopic dermatitis patients have a positive family history of atopic diseases
      • Risk of developing atopic dermatitis is 2- to 3-fold higher in children with 1 atopic parent [2]
      • Risk of developing atopic dermatitis is 3- to 5-fold higher in children with both atopic parents [3]
    • Loss of function mutations in the filaggrin (FLG) gene[4]
      • Risk for earlier-onset atopic dermatitis
      • Risk for severe and persistent atopic dermatitis
    • Personal history of atopy (asthma, allergic rhinitis, food allergy) [5]
    • Environmental factors predisposing individuals to the development of atopic dermatitis include:[6]
      • Temperature (colder climates with low humidity)
      • Ultraviolet radiation
      • Air pollution
      • Water hardness
      • Household hygiene

Less Common Risk Factors

References

  1. ↑ Wen HJ, Chen PC, Chiang TL, Lin SJ, Chuang YL, Guo YL (November 2009). "Predicting risk for early infantile atopic dermatitis by hereditary and environmental factors". Br. J. Dermatol. 161 (5): 1166–72. doi:10.1111/j.1365-2133.2009.09412.x. PMID 19785611.
  2. ↑ Küster W, Petersen M, Christophers E, Goos M, Sterry W (1990). "A family study of atopic dermatitis. Clinical and genetic characteristics of 188 patients and 2,151 family members". Arch. Dermatol. Res. 282 (2): 98–102. PMID 2353830.
  3. ↑ Küster W, Petersen M, Christophers E, Goos M, Sterry W (1990). "A family study of atopic dermatitis. Clinical and genetic characteristics of 188 patients and 2,151 family members". Arch. Dermatol. Res. 282 (2): 98–102. PMID 2353830.
  4. ↑ Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, Lee SP, Goudie DR, Sandilands A, Campbell LE, Smith FJ, O'Regan GM, Watson RM, Cecil JE, Bale SJ, Compton JG, DiGiovanna JJ, Fleckman P, Lewis-Jones S, Arseculeratne G, Sergeant A, Munro CS, El Houate B, McElreavey K, Halkjaer LB, Bisgaard H, Mukhopadhyay S, McLean WH (April 2006). "Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis". Nat. Genet. 38 (4): 441–6. doi:10.1038/ng1767. PMID 16550169.
  5. ↑ Suh KY (June 2010). "Food allergy and atopic dermatitis: separating fact from fiction". Semin Cutan Med Surg. 29 (2): 72–8. doi:10.1016/j.sder.2010.03.007. PMID 20579595.
  6. ↑ Garmhausen D, Hagemann T, Bieber T, Dimitriou I, Fimmers R, Diepgen T, Novak N (April 2013). "Characterization of different courses of atopic dermatitis in adolescent and adult patients". Allergy. 68 (4): 498–506. doi:10.1111/all.12112. PMID 23452057.
  7. ↑ McKeever TM, Lewis SA, Smith C, Collins J, Heatlie H, Frischer M, Hubbard R (January 2002). "Early exposure to infections and antibiotics and the incidence of allergic disease: a birth cohort study with the West Midlands General Practice Research Database". J. Allergy Clin. Immunol. 109 (1): 43–50. PMID 11799364.
  8. ↑ McKeever TM, Lewis SA, Smith C, Hubbard R (September 2002). "The importance of prenatal exposures on the development of allergic disease: a birth cohort study using the West Midlands General Practice Database". Am. J. Respir. Crit. Care Med. 166 (6): 827–32. doi:10.1164/rccm.200202-158OC. PMID 12231492.
  9. ↑ Wen HJ, Chen PC, Chiang TL, Lin SJ, Chuang YL, Guo YL (November 2009). "Predicting risk for early infantile atopic dermatitis by hereditary and environmental factors". Br. J. Dermatol. 161 (5): 1166–72. doi:10.1111/j.1365-2133.2009.09412.x. PMID 19785611.
  10. ↑ Martignon G, Oryszczyn MP, Annesi-Maesano I (May 2005). "Does childhood immunization against infectious diseases protect from the development of atopic disease?". Pediatr Allergy Immunol. 16 (3): 193–200. doi:10.1111/j.1399-3038.2005.00254.x. PMID 15853947.
  11. ↑ Perkin MR, Craven J, Logan K, Strachan D, Marrs T, Radulovic S, Campbell LE, MacCallum SF, McLean WH, Lack G, Flohr C (August 2016). "Association between domestic water hardness, chlorine, and atopic dermatitis risk in early life: A population-based cross-sectional study". J. Allergy Clin. Immunol. 138 (2): 509–16. doi:10.1016/j.jaci.2016.03.031. PMID 27241890.
  12. ↑ Weber AS, Haidinger G (November 2010). "The prevalence of atopic dermatitis in children is influenced by their parents' education: results of two cross-sectional studies conducted in Upper Austria". Pediatr Allergy Immunol. 21 (7): 1028–35. doi:10.1111/j.1399-3038.2010.01030.x. PMID 20444159.
  13. ↑ Schram ME, Tedja AM, Spijker R, Bos JD, Williams HC, Spuls PI (May 2010). "Is there a rural/urban gradient in the prevalence of eczema? A systematic review". Br. J. Dermatol. 162 (5): 964–73. doi:10.1111/j.1365-2133.2010.09689.x. PMID 20331459.
  14. ↑ Tsakok T, McKeever TM, Yeo L, Flohr C (November 2013). "Does early life exposure to antibiotics increase the risk of eczema? A systematic review". Br. J. Dermatol. 169 (5): 983–91. doi:10.1111/bjd.12476. PMID 23782060.
  15. ↑ Kantor R, Kim A, Thyssen JP, Silverberg JI (December 2016). "Association of atopic dermatitis with smoking: A systematic review and meta-analysis". J. Am. Acad. Dermatol. 75 (6): 1119–1125.e1. doi:10.1016/j.jaad.2016.07.017. PMC 5216172. PMID 27542586.
  16. ↑ Arndt J, Smith N, Tausk F (July 2008). "Stress and atopic dermatitis". Curr Allergy Asthma Rep. 8 (4): 312–7. PMID 18606083.
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