No clear consensus regarding the diagnostic work-up that should be performed when evaluating patients with AD, particularly adults, has emerged. Diagnostic approaches have large variation.1
Chronic pruritus and itch induces scratch behavior, which can serve as a physiologic self-protective mechanism to prevent the body from being hurt by harmful external agents, but is well recognized to damage skin and increase inflammation, further exacerbating pruritus, resulting in the ‘‘itch-scratch cycle.’’2
Clinical phenotypes and endotypes are characterized by a wide range of heterogeneity in the onset, course, and presentation of AD, as well as in individual comorbidities.
The diagnosis of AD remains clinical, as there are no known reliable biomarkers that can distinguish AD from other diseases.3,4
Guidelines of care for the management of AD issued in 2014 reported 28 different scales for the measurement of disease severity, without a single gold standard emerging.4
Figure 1: Multidisciplinary Approach to AD 10,11
The propensity toward allergic disorders (asthma, food allergy, allergic rhinoconjunctivitis, and eosinophilic esophagitis) and skin infection (especially Staphylococcus aureus and widespread herpes/eczema herpeticum) is clearly increased in patients with AD.5-8
Neuropsychiatric issues (attention-deficit/hyperactivity disorder, depression, anxiety, conduct disorder, autism, and suicidal ideation) have been linked to AD recently.5-8
Assessment of disease severity is further complicated by a disconnect between physicians and their patients. The results of one study suggested that patients and physicians disagreed on the severity level of AD in approximately one-third of cases.9
Maintaining motivation and treatment adherence in patients with AD is an important, yet often difficult undertaking.
Proper management of the direct and indirect effects of AD often requires expertise beyond the scope of dermatology. A multidisciplinary approach can treat common comorbidities, improve patient quality of life, reduce polypharmacy, and improve communication between providers.10
Figure 2: The Multidisciplinary Approach to AD 10
Darsow U, et al. ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol. 2010;24:317-328.
Paller AS, et al. Therapeutic pipeline for atopic dermatitis: End of the drought? J Allergy Clin Immunol. 2017;140:633-643.
Silvestre Salvador JF, et al. Atopic dermatitis in adults: A diagnostic challenge. J Investig Allergol Clin Immunol. 2017;27:78-88.
Eichenfield LF, et al. Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70:338-351.
Schmitt J, et al. Atopic eczema and attention-deficit/hyperactivity disorder in a population-based sample of children and adolescents. JAMA. 2009;301:724-726.
Miyazaki C, et al. Allergic diseases in children with attention deficit hyperactivity disorder: A systematic review and meta-analysis. BMC Psychiatry. 2017;17:120.
Strom MA, et al. Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults. Br J Dermatol. 2016;175:920-929.
Thyssen JP, et al. Atopic dermatitis is associated with anxiety, depression, and suicidal ideation, but not with hospitalization or suicide. Allergy. 2018;73:214-220.
Wei W, Anderson P, Gadkari A, et al. Discordance between physician- and patient-reported disease severity in adults with atopic dermatitis: A US cross-sectional survey. Am J Clin Dermatol. 2017;18:825-835.
Nataloni R. Multidisciplinary approach to eczema treatment. Dermatologist. 2016;24.
Silverberg JI. Comorbidities and the impact of atopic dermatitis. Ann Allergy Asthma Immunol. 2019;123:144-151.