The role of in atopic eczema: treatment strategies

Subject Therapy of atopic dermatitis. Aim To outline treatment strategies for atopic dermatitis patients. Methods Description of therapeutic principles of atopic dermatitis. Results Atopic eczema arises as a result of the interaction of environmental factors with an abnormal immune system in a genetically predisposed individual. Also the skin of patients with atopic eczema carries high levels of Staphylococcus aureus , which correlate with the severity of the eczema. Staphylococcus aureus releases a toxin with superantigenic actions which initiates a vicious circle in atopic eczema. Therapy of atopic eczema will be more effective if it breaks the vicious circle at two points. Topical steroids inhibit the action and production of pro-inflammatory mediators breaking the circle at one point. Intensive emollient therapy and antibiotic steroid combinations reduce the number of Staphylococcus aureus and the penetratioin of the toxins through the skin, thereby breaking the circle at a second point. Conclusion Using the approach of reducing both the effects of cytokines and of superantigens, it is possible to reduce the potency and quantity of topical steroids applied and therefore their cutaneous adverse effects.