Issues of diagnosis and treatment of atopic dermatitis

Atopic dermatitis (AD) is the most common disease affecting ~30% of children and ~10% of adults in all countries. AD is associated with atopy and often precedes the development of allergic rhinitis and asthma. At the moment there are some unclear issues of AD pathogenesis. Thus, ~20% of patients with AD have a normal level of Class E (IgE) antibodies responsible for atopy. Accordingly, groups with elevated (exogenous AD) and normal (endogenous AD) IgE level are identified. Moreover, the severity of AD is only slightly less in endogenous AD. Literature data analysis showed that patients of endogenous AD group have family history of atopy, but don’t have increased IgE level. The role of mutations in filaggrin gene in AD is the second unclear issue. Mutations in the filaggrin gene are distributed unevenly across ethnic groups and revealed only in AD. At the same time, the severity of AD is slightly higher in patients (mainly in children) with identified mutations. The review shows that role of mutations in the filaggrin gene and IgE presence play a minor role in AD pathogenesis. A genetic reduction in the barrier function not only of the skin but also other mucous membranes is the main cause of AD. Commensal flora of the skin that leads to activation of innate and then adaptive immune system is the trigger in AD. The use of moisturizes and topical corticosteroids is the first-line treatment of AD. This article presents data of our own clinical observations of the use of micronized agent containing methylprednisolone aceponate and ceramides for the treatment of various forms of AD. Clinical experience of the agent use demonstrated a high therapeutic efficacy and low risk of adverse events. High efficacy, safety and optimal pharmacoeconomic index increase patients’ adherence to the treatment.