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Overview of Atopic Dermatitis
Carmela Avena-Woods, BS Pharm, PharmD, BCGP
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Atopic Dermatitis: Focusing on the Patient Care Strategy in the Managed Care Setting

Overview of Atopic Dermatitis

Carmela Avena-Woods, BS Pharm, PharmD, BCGP
Atopic dermatitis (AD), also known as atopic eczema, is a chronic relapsing inflammatory skin condition. Incidence of AD has increased 2- to 3-fold in industrialized nations, impacting approximately 15% to 20% of children and 1% to 3% of adults worldwide. AD has a wide-ranging impact on a patient’s quality of life and the burden from direct and indirect costs (approximately $37.7 billion in out-of-pocket costs) is shared by the families and caregivers of patients with AD. This article reviews the epidemiology, burden of disease, pathophysiology, and diagnostic criteria important for early diagnosis and treatment. New insights related to the genetic, immunologic, and environmental impacts of AD have created new treatment opportunities. Nonpharmacologic and pharmacologic interventions are discussed, with an emphasis on emerging treatments for AD. Healthcare providers play an important role in the management of AD to improve economic and clinical outcomes. Treatment strategies need to be individualized with a strong emphasis on patient education and self-management strategies to optimize outcomes and reduce unnecessary costs associated with the management of AD.
Am J Manag Care. 2017;23:-S0

Atopic dermatitis (AD) is a multifaceted, chronic relapsing inflammatory skin disease that is commonly associated with other atopic manifestations such as food allergy, allergic rhinitis, and asthma.1-3 It is the most common skin disease in children, affecting approximately 15% to 20% of children and 1% to 3% of adults.4,5 Onset of disease is most common by 5 years of age, and early diagnosis and treatment are essential to avoid complications of AD and improve quality of life.5 Individuals with AD were formerly referred to as individuals having eczema. However, the word “eczema” is a broad term that refers to various conditions causing inflammation of the skin. The purpose of this lesson is to review the epidemiology, burden of disease, pathophysiology, diagnostic criteria, and clinical presentation of AD to ensure that patients are correctly diagnosed and receive care in an appropriate and timely manner.

Epidemiology
Incidence of AD, also referred to as atopic eczema, has increased 2- to 3-fold in industrialized nations since the 1970s, with approximately 15% to 20% of children and 1% to 3% of adults affected worldwide.4,5 Population-based studies in the United States suggest that prevalence is about 10.7% for children and 7.2% for adults.6,7 Onset of disease commonly presents by 5 years of age, with the highest incidence occurring between the ages of 3 and 6 months, but it can occur at any age.5,8 Approximately 60% of patients develop disease in the first year of life and 90% within the first 5 years of life.5 Twenty percent of children who develop AD before 2 years of age will have persisting symptoms of disease; 17% will have intermittent symptoms by 7 years of age. Only 16.8% of adults with AD experience onset after adolescence.9-11 AD commonly resolves by the time a child reaches adulthood; however, approximately 10% to 30% of patients will continue to have symptoms of disease.12 A 2014 prospective cohort study of children with mild-to-moderate AD reported that, at any age, including up to 26 years of age, 80% of participants with ≥5 years of follow-up continued to have symptoms or had continued using medications for their AD.13 Interestingly, investigators from the same cohort study identified that regardless of disease severity, participants sought out their healthcare provider less frequently as they aged, suggesting that this may account for the common perception that AD resolves over time.13 In contrast, a 2016 meta-analysis showed that only 20% of childhood AD persisted 8 years after onset and there was a median duration of 3 years for AD persistence.14 Furthermore, AD was shown to be more persistent in males, in patients with late-onset disease, and in those with severe cases of the disease. Even with the inconsistencies among the above-mentioned studies, it is clear that AD is a chronic disease that is burdensome for many patients. A 2007 study further supports this claim, as an estimated 17.8 million persons, mostly undiagnosed, are living with AD in the United States.8



 
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