A therapeutic approach to atopic eczema

Abstract

Atopic eczema is a common problem in general practice. The underlying disorder is a barrier dysfunction of the skin, but exacerbations of eczema can be triggered by a range of external and internal factors. In young children, dietary factors are important triggers of exacerbations and specific IgE sensitivity to common allergens may be confirmed by skin prick testing or ImmunoCap® RAST tests. True sensitivity to foods is best confirmed by a controlled food challenge, and cut off values have been published which indicate the predictive values of blood or skin tests for true food sensitivity to guide the clinician. Elimination of identifiable triggers, the use of emollients and topical corticosteroids remain the mainstay of treatments. Calcineurin inhibitors have a place for treatment of selected cases. The use of systemic corticosteroids is discouraged and patients who do not respond to emollients, specific food avoidance and corticosteroids topically should be referred to a dermatologist. The role of maternal diet in preventing the development of eczema in the offspring remains controversial.