INTRODUCTION
Atopic dermatitis (AD) or eczema is a chronic, relapsing, inflammatory skin disease, which affects up to 25% of children and 2-3% of adults.1 Hereditary and environmental factors predict a higher risk for early infantile atopic dermatitis.3 The diagnosis of AD is clinical: chronic, relapsing course, dry irritated skin, pruritus, erythema, scaling, edema, excoriations/erosions, oozing, crusting, and licheni cation in characteristic locations based on age (ie, facial, neck, and exten- sors in infants and children). Flexural involvement may occur at any age; sparing of groin and axillae.4There is often co-existing asthma and hay fever.3 Itch is a predominant feature to the point where AD has often been referred to as the “itch that rashes.”2 There are many triggers that may aggravate AD and different triggers play different roles in individual patients. Examples of triggers that can exacerbate eczema include but are not limited to soaps/detergents/perfumes, rough fabrics, allergens (eg, animal dander, dust mites, mold, pollen, perfume, food), stress, environmental (dryness/ cold), sweating, and secondary infection/bacterial colonization.1 Patient/parent ed- ucation should be directed towards identifying and avoiding eczema triggers. Many patients with eczema suffer more in the winter when the weather is dry and cold, while other suffer more in a warm, humid environment.1,2 AD interferes with quality of life in children and parents of af- fected children more than most other conditions including other skin conditions.5-9 Intense itching frequently leads to sig- ni cant sleep disturbances as well as irritability and reduced performance at school and work. 5-9 Even in remission, AD can have long term behavioral and neurocognitive effects.9 Quality of life may be further reduced due to the social stigma of the visible skin condition.7 The skin of patients with AD has a compromised skin barrier function. Filaggrin null gene mutations and a high total serum IgE level tend to be associated with more severe, chronic disease, but not all patients with AD have a laggrin defect or high
