Atopic dermatitis

Nat Rev Dis Primers. 2018 Jun 21;4(1):1. doi: 10.1038/s41572-018-0001-z.


Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a lifetime prevalence of up to 20% and substantial effects on quality of life. AD is characterized by intense itch, recurrent eczematous lesions and a fluctuating course. AD has a strong heritability component and is closely related to and commonly co-occurs with other atopic diseases (such as asthma and allergic rhinitis). Several pathophysiological mechanisms contribute to AD aetiology and clinical manifestations. Impairment of epidermal barrier function, for example, owing to deficiency in the structural protein filaggrin, can promote inflammation and T cell infiltration. The immune response in AD is skewed towards T helper 2 cell-mediated pathways and can in turn favour epidermal barrier disruption. Other contributing factors to AD onset include dysbiosis of the skin microbiota (in particular overgrowth of Staphylococcus aureus), systemic immune responses (including immunoglobulin E (IgE)-mediated sensitization) and neuroinflammation, which is involved in itch. Current treatments for AD include topical moisturizers and anti-inflammatory agents (such as corticosteroids, calcineurin inhibitors and cAMP-specific 3',5'-cyclic phosphodiesterase 4 (PDE4) inhibitors), phototherapy and systemic immunosuppressants. Translational research has fostered the development of targeted small molecules and biologic therapies, especially for moderate-to-severe disease.

Publication types

  • Review

MeSH terms

  • Administration, Topical
  • Adrenal Cortex Hormones / therapeutic use
  • Azathioprine / therapeutic use
  • Boron Compounds / therapeutic use
  • Bridged Bicyclo Compounds, Heterocyclic / therapeutic use
  • Calcineurin Inhibitors / therapeutic use
  • Chronic Disease / epidemiology
  • Chronic Disease / therapy
  • Dermatitis, Atopic / drug therapy*
  • Dermatitis, Atopic / epidemiology
  • Dermatitis, Atopic / physiopathology*
  • Filaggrin Proteins
  • Genetic Predisposition to Disease / epidemiology
  • Genetic Predisposition to Disease / genetics
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Intermediate Filament Proteins / analysis
  • Intermediate Filament Proteins / genetics
  • Methotrexate / therapeutic use
  • Phosphodiesterase 4 Inhibitors / therapeutic use
  • Quality of Life / psychology
  • Severity of Illness Index
  • Urticaria / etiology
  • Urticaria / genetics


  • Adrenal Cortex Hormones
  • Boron Compounds
  • Bridged Bicyclo Compounds, Heterocyclic
  • Calcineurin Inhibitors
  • FLG protein, human
  • Filaggrin Proteins
  • Immunosuppressive Agents
  • Intermediate Filament Proteins
  • Phosphodiesterase 4 Inhibitors
  • Azathioprine
  • crisaborole
  • Methotrexate