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Advances in Pediatrics

Atopic Dermatitis

      Atopic dermatitis is a chronically relapsing dermatosis characterized by pruritus, erythema, vesiculation, papulation, exudation, excoriation, crusting, scaling, and sometimes lichenification [
      • Leung A.K.C.
      • Barber K.A.
      Managing childhood atopic dermatitis.
      ]. The word atopic comes from the Greek word atopos, which means “strange” or “unusual.” Atopic eczema is synonymous with atopic dermatitis. The word eczema is from the Greek word ekzema, which means to “erupt” or “boil over.” Atopic dermatitis is an “itch that rashes.”
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      References

        • Leung A.K.C.
        • Barber K.A.
        Managing childhood atopic dermatitis.
        Adv Ther. 2003; 20: 129-137
        • Leung D.Y.M.
        • Boguniewicz M.
        • Howell M.D.
        • et al.
        New insights into atopic dermatitis.
        J Clin Invest. 2004; 133: 651-657
        • Grillo M.
        • Ng M.
        • Gassner L.
        • et al.
        Pediatric atopic eczema: the impact of an educational intervention.
        Pediatr Dermatol. 2006; 23: 428-436
        • Cheigh N.H.
        Managing a common disorder in children: atopic dermatitis.
        J Pediatr Health Care. 2003; 17: 84-88
        • Boguniewicz M.
        Update on atopic dermatitis: insights into pathogenesis and new treatment paradigms.
        Allergy Asthma Proc. 2004; 25: 279-282
        • Dohil M.A.
        • Eichenfield L.F.
        A treatment approach for atopic dermatitis.
        Pediatr Ann. 2005; 34: 201-210
        • Boguniewicz M.
        • Leung D.Y.M.
        Atopic dermatitis.
        J Allergy Clin Immunol. 2006; 117: S475-S480
        • Hon K.L.E.
        • Kan W.Y.C.
        • Lam M.C.A.
        • et al.
        CQLQ1, SCORAD and NESS: are they correlated?.
        Qual Life Res. 2006; 15: 1551-1558
        • Foroughi S.
        • Thyagarajan A.
        • Stone K.D.
        Advances in pediatric asthma and atopic dermatitis.
        Curr Opin Pediatr. 2005; 17: 658-663
        • Leung D.Y.M.
        • Nicklas R.A.
        • Li J.T.
        • et al.
        Disease management of atopic dermatitis: an updated practice parameter.
        Ann Allergy Asthma Immunol. 2004; 93: S1-S21
        • Abramovits W.
        Atopic dermatitis.
        J Am Acad Dermatol. 2005; 53: S86-S93
        • Simpson E.L.
        • Hanifin J.M.
        Atopic dermatitis.
        J Am Acad Dermatol. 2005; 53: 115-128
        • Williams L.K.
        • Peterson E.L.
        • Ownby D.R.
        • et al.
        The relationship between early fever and allergic sensitization at age 6 to 7 years.
        J Allergy Clin Immunol. 2004; 113: 291-296
        • Kuster W.
        • Petersen M.
        • Christophers E.
        • et al.
        A family study of atopic dermatitis. Clinical and genetic characteristics of 188 patients and 2,151 family members.
        Arch Dermatol Res. 1990; 282: 98-102
        • Roos T.C.
        • Geuer S.
        • Roos S.
        • et al.
        Recent advances in treatment strategies for atopic dermatitis.
        Drugs. 2004; 64: 2639-2666
        • Diepgen T.L.
        • Blettner M.
        Analysis of familial aggregation of atopic eczema and other atopic diseases by ODDS RATIO regression models.
        J Invest Dermatol. 1996; 106: 977-981
        • Morar N.
        • Willis-Owen S.A.G.
        • Moffatt M.F.
        • et al.
        The genetics of atopic dermatitis.
        J Allergy Clin Immunol. 2006; 118: 24-34
        • Schultz Larsen F.
        Atopic dermatitis: a genetic-epidemiologic study in a population-based twin sample.
        J Am Acad Dermatol. 1993; 28: 719-723
        • Haagerup A.
        • Bjerke T.
        • Schiøtz P.O.
        • et al.
        Atopic dermatitis—a total genome-scan for susceptibility genes.
        Acta Derm Venereol (Stockh). 2004; 84: 346-352
        • Leung D.Y.M.
        • Jian N.
        • Leo H.L.
        New concepts in the pathogenesis of atopic dermatitis.
        Curr Opin Immunol. 2003; 15: 634-638
        • Hara J.
        • Higuchi K.
        • Okamoto R.
        • et al.
        High-expression of sphingomyelin deacylase is an important determinant of ceramide deficiency leading to barrier disruption in atopic dermatitis.
        J Invest Dermatol. 2000; 115: 406-413
        • Imokawa G.
        Lipid abnormalities in atopic dermatitis.
        J Am Acad Dermatol. 2001; 45: S29-S32
        • Beltrani V.S.
        • Boguneiwicz M.
        Atopic dermatitis.
        Dermatol Online J. 2003; 9: 1
        • Sator P.G.
        • Schmidt J.B.
        • Hönigsmann H.
        Comparison of epidermal hydration and skin surface lipids in healthy individuals and in patients with atopic dermatitis.
        J Am Acad Dermatol. 2003; 48: 352-358
        • Ong P.Y.
        • Ohtake T.
        • Brandt C.
        • et al.
        Endogenous antimicrobial peptides and skin infections in atopic dermatitis.
        N Engl J Med. 2002; 347: 1151-1160
        • Boguniewicz M.
        • Eichenfield L.F.
        • Hultsch T.
        Current management of atopic dermatitis and interruption of the atopic march.
        J Allergy Clin Immunol. 2003; 112: S140-S149
        • Cho S.H.
        • Strickland I.
        • Boguniewicz M.
        • et al.
        Fibronectin and fibrinogen contribute to the enhanced binding of Staphylococcus aureus to atopic skin.
        J Allergy Clin Immunol. 2001; 108: 269-274
        • Baker B.S.
        The role of microorganisms in atopic dermatitis.
        Clin Exp Immunol. 2006; 114: 1-9
        • Wedi B.
        • Wieczorek D.
        • Stünkel T.
        • et al.
        Staphylococcal exotoxins exert proinflammatory effects through inhibition of eosinophil apoptosis, increased surface antigen expression (CD11b, CD45, CD54, and CD69), and enhanced cytokine-activated oxidative burst, thereby triggering allergic inflammatory reactions.
        J Allergy Clin Immunol. 2002; 109: 477-484
        • Bunikowski R.
        • Mielke M.
        • Skarabis H.
        • et al.
        Prevalence and role of serum IgE antibodies to the Staphylococcus aureus-derived superantigens SEA and SEB in children with atopic dermatitis.
        J Allergy Clin Immunol. 1999; 103: 119-124
        • Hofer M.F.
        • Harbeck R.J.
        • Schlievert P.M.
        • et al.
        Staphylococcal toxins augment specific IgE responses by atopic patients exposed to allergen.
        J Invest Dermatol. 1999; 112: 171-176
        • Hauk P.J.
        • Hamid Q.A.
        • Chrousos G.P.
        • et al.
        Induction of corticosteroid insensitivity in human PBMCs by microbial superantigens.
        J Allergy Clin Immunol. 2000; 105: 782-787
        • Nissen D.
        • Petersen L.J.
        • Esch R.
        • et al.
        IgE–sensitization to cellular and culture filtrates of fungal extracts in patients with atopic dermatitis.
        Ann Allergy Asthma Immunol. 1998; 81: 247-255
        • Wessels M.W.
        • Doeks G.
        • Van Ieperen-Van Dijk A.G.
        • et al.
        IgE antibodies to Pityrosporon ovale in atopic dermatitis.
        Br J Dermatol. 1991; 125: 227-232
        • Buentke E.
        • Scheynius A.
        Dendritic cells and fungi.
        APMIS. 2003; 111: 789-796
        • Levy R.M.
        • Gelfand J.M.
        • Yan A.C.
        The epidemiology of atopic dermatitis.
        Clin Dermatol. 2003; 21: 109-115
        • Kalliomäki M.
        • Isolauri E.
        Role of intestinal flora in the development of allergy.
        Curr Opin Allergy Clin Immunol. 2003; 3: 15-20
        • Watanabe S.
        • Narisawa Y.
        • Arase S.
        • et al.
        Differences in fecal microflora between patients with atopic dermatitis and healthy control subjects.
        J Allergy Clin Immunol. 2003; 111: 587-591
        • Leung A.K.C.
        Food allergy: a clinical approach.
        Adv Pediatr. 1998; 45: 145-177
        • Werfel T.
        • Breuer K.
        Role of food allergy in atopic dermatitis.
        Curr Opin Allergy Clin Immunol. 2004; 4: 379-385
        • Burks A.W.
        • Mallroy S.B.
        • Williams L.W.
        • et al.
        Atopic dermatitis: clinical relevance of food hypersensitivity reactions.
        J Pediatr. 1988; 113: 447-451
        • Hoffman K.M.
        • Sampson H.A.
        Evaluation and management of patients with adverse food reactions.
        in: Bierman C.W. Pearlman D.S. Shapiro G.G. Allergy, asthma, and immunology from infancy to adulthood. W.B. Saunders, Philadelphia1999: 665-686
        • Sampson H.A.
        The immunopathogenic role of food hypersensitivity in atopic dermatitis.
        Acta Derm Venereol. 1992; 176: 534-537
        • Sampson H.A.
        Food sensitivity and the pathogenesis of atopic dermatitis.
        J R Soc Med. 1997; 90: 2-8
        • Breuer K.
        • Heratizadeh A.
        • Wulf A.
        • et al.
        Late eczematous reactions to food in children with atopic dermatitis.
        Clin Exp Allergy. 2004; 34: 817-824
        • Hill D.J.
        • Hosking C.S.
        Food allergy and atopic dermatitis in infancy: an epidemiologic study.
        Pediatr Allergy Immunol. 2004; 15: 421-427
        • Leung A.K.C.
        • Bowen T.J.
        Seasonal allergic rhinitis and food allergy.
        in: Bergan A.B. Twenty common problems in pediatrics. McGraw-Hill, New York2001: 219-233
        • Tupker R.A.
        • De Monchy J.G.R.
        • Coenraads P.J.
        • et al.
        Induction of atopic dermatitis by inhalation of house dust mite.
        J Allergy Clin Immunol. 1996; 97: 1064-1070
        • Krämer U.
        • Lemmen C.H.
        • Behrendt H.
        • et al.
        The effect of environmental tobacco smoke on eczema and allergic sensitization in children.
        Br J Dermatol. 2004; 150: 111-118
        • Sturgill S.
        • Bernard L.A.
        Atopic dermatitis update.
        Curr Opin Pediatr. 2004; 16: 396-401
        • Darsow U.
        • Lübbe J.
        • Taïab A.
        • et al.
        Position paper on diagnosis and treatment of atopic dermatitis.
        J Eur Acad Dermatol Venereol. 2005; 19: 286-295
        • Manzini B.M.
        • Ferdani G.
        • Simonetti V.
        • et al.
        Contact sensitization in children.
        Contact Derm. 1998; 15: 12-17
        • Mortz C.G.
        • Andersen K.E.
        Allergic contact dermatitis in children and adolescents.
        Contact Derm. 1999; 41: 121-130
        • Schmid-Ott G.
        • Jaeger B.
        • Meyer S.
        • et al.
        Different expression of cytokine and membrane molecules by circulating lymphocytes on acute mental stress in patients with atopic dermatitis in comparison with healthy controls.
        J Allergy Clin Immunol. 2001; 108: 455-462
        • Akdis C.A.
        • Akdi M.
        • Bieber T.
        • et al.
        Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report.
        J Allergy Clin Immunol. 2006; 118: 152-169
        • Beltrani V.S.
        Suggestions regarding a more appropriate understanding of atopic dermatitis.
        Curr Opin Allergy Clin Immunol. 2005; 5: 413-418
        • Rudikoff D.
        • Lebwohl M.
        Atopic dermatitis.
        Lancet. 1998; 351: 1715-1721
        • Kristal L.
        • Klein P.A.
        Atopic dermatitis in infants and children.
        Pediatr Clin North Am. 2000; 47: 877-895
        • Halkjær L.B.
        • Loland L.
        • Buchvald F.F.
        • et al.
        Development of atopic dermatitis during the first 3 years of life: the Copenhagen Prospective Study on Asthma in Childhood cohort study in high-risk children.
        Arch Dermatol. 2006; 142: 561-566
        • Eigenmann P.A.
        Clinical features and diagnostic criteria of atopic dermatitis in relation to age.
        Pediatr Allergy Immunol. 2001; 12: 69-74
        • Hanifin J.M.
        Atopic dermatitis.
        J Am Acad Dermatol. 1982; 6: 1-13
        • Leung A.K.C.
        • Feingold M.
        Pityriasis alba.
        AJDC. 1986; 140: 379-380
        • Leung A.K.C.
        • Kao C.P.
        Keratosis pilaris.
        Consultant Pediatrician. 2004; 3: 188-191
        • Leung A.K.C.
        • Robson W.L.M.
        Ichthyosis vulgaris.
        Consultant Pediatrician. 2006; 5: 573-575
        • Kang K.
        • Polster A.M.
        • Nedorost S.
        • et al.
        Atopic dermatitis.
        in: Bolognia J.L. Jorizzo J.L. Rapini R.P. Dermatology. Mosby, Philadelphia2003: 199-214
        • Krafchik B.R.
        • Halbert A.
        • Yamamoto K.
        • et al.
        Atopic dermatitis.
        in: Schachner L.A. Hansen R.C. Happle R. Pediatric dermatology. 3rd edition. Mosby, Philadelphia2003: 599-630
        • Hanifin J.M.
        • Rajka G.
        Diagnostic features of atopic dermatitis.
        Acta Derm Venereol (Stockh). 1980; 92: 44-47
        • Bohme M.
        • Svensson A.
        • Kull I.
        • et al.
        Hanifin's and Rajka's minor criteria for atopic dermatitis. Which do 2-year-olds exhibit?.
        J Am Acad Dermatol. 2000; 43: 285-292
        • Nagaraja
        • Kanwar A.J.
        • Dhar S.
        • et al.
        Frequency and significance of minor clinical features in various age-related subgroups of atopic dermatitis in children.
        Pediatr Dermatol. 1996; 13: 10-13
        • Williams H.C.
        • Burney P.G.
        • Pembroke A.C.
        • et al.
        The U.K. Working Party's diagnostic criteria for atopic dermatitis, III: independent hospital validation.
        Br J Dermatol. 1994; 131: 406-416
        • Eichenfield L.F.
        • Hanifin J.M.
        • Luger T.A.
        • et al.
        Consensus conference on pediatric AD.
        J Am Acad Dermatol. 2003; 49: 1088-1095
        • Eichenfield L.F.
        Consensus guidelines in diagnosis and treatment of atopic dermatitis.
        Allergy. 2004; 59: 86-92
        • European Task Force on Atopic dermatitis
        Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on atopic dermatitis.
        Dermatology. 1993; 186: 23-31
        • Hon K.L.E.
        • Leung T.F.
        • Wong Y.
        • et al.
        Lesson from performing SCORADs in children with atopic dermatitis: subjective symptoms do not correlate well with disease extent or intensity.
        Int J Dermatol. 2006; 45: 728-730
        • Kunz B.
        • Oranje A.P.
        • Labrèze L.
        • et al.
        Clinical validation and guidelines for the SCORAD Index: consensus report of the European Task Force on Atopic dermatitis.
        Dermatology. 1997; 195: 10-19
        • Benjamin K.
        • Waterston K.
        • Russell M.
        • et al.
        The development of an objective method for measuring scratch in children with atopic dermatitis suitable for clinical use.
        J Am Acad Dermatol. 2004; 50: 33-40
        • Hon K.L.E.
        • Lam M.C.A.
        • Leung T.F.
        • et al.
        Nocturnal wrist movements are correlated with objective clinical scores and plasma chemokine levels in children with atopic dermatitis.
        Br J Dermatol. 2006; 154: 629-635
        • Hon K.L.E.
        • Lam M.C.A.
        • Leung T.F.
        • et al.
        Assessing itch in children with atopic dermatitis treated with tacrolimus: objectivity versus subjectivity in assessment.
        Adv Ther. 2007; 24: 23-28
        • Hanifin J.M.
        • Thurston M.
        • Omoto M.
        • et al.
        The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group.
        Exp Dermatol. 2001; 10: 11-18
        • Emerson R.M.
        • Charman C.R.
        • Williams H.C.
        The Nottingham Eczema Severity Score: preliminary refinement of the Rajka and Langeland grading.
        Br J Dermatol. 2000; 142: 288-297
        • Hon K.L.E.
        • Ma K.C.
        • Wong E.
        • et al.
        Validation of a self-administered questionnaire in Chinese in the assessment of eczema severity.
        Pediatr Dermatol. 2003; 20: 465-469
        • Leung T.F.
        • Ma K.C.
        • Hon K.L.
        • et al.
        Serum concentration of macrophage-derived chemokine might be a useful inflammatory marker for assessing severity of atopic dermatitis in infants and young children.
        Pediatr Allergy Immunol. 2003; 14: 296-301
        • Hon K.L.E.
        • Leung T.F.
        • Ma K.C.
        • et al.
        Serum levels of cutaneous T cell attracting chemokine (CTACK) as a laboratory marker of the severity of atopic dermatitis in children.
        Clin Exp Dermatol. 2004; 29: 293-296
        • Hon K.L.E.
        • Leung T.F.
        • Ma K.C.
        • et al.
        Urinary leukotriene E4 correlates with severity of atopic dermatitis in children.
        Clin Exp Dermatol. 2004; 29: 277-281
        • Hon K.L.E.
        • Leung T.F.
        • Ma K.C.
        • et al.
        Serum concentration of IL-18 correlates with disease extent in young children with atopic dermatitis.
        Pediatr Dermatol. 2004; 21: 619-622
        • Leung T.F.
        • Wong C.K.
        • Chan I.H.
        • et al.
        Plasma concentration of thymus and activation-regulated chemokine is elevated in childhood asthma.
        J Allergy Clin Immunol. 2002; 110: 404-409
        • Leung T.F.
        • Wong C.K.
        • Lam C.W.K.
        • et al.
        Plasma TARC concentration might be a useful marker for asthmatic exacerbation in children.
        Eur Respir J. 2003; 21: 616-620
        • Morales J.
        • Homey B.
        • Vicari A.P.
        • et al.
        CTACK, a skin-associated chemokine that preferentially attracts skin-homing memory T cells.
        Proc Natl Acad Sci USA. 1999; 96: 14470-14475
        • Ben-Gashir M.A.
        • Seed P.T.
        • Hay R.J.
        Quality of life and disease severity are correlated in children with atopic dermatitis.
        Br J Dermatol. 2004; 150: 284-290
        • Holm E.A.
        • Wulf H.C.
        • Stegmann H.
        • et al.
        Life quality assessment among patients with atopic eczema.
        Br J Dermatol. 2006; 154: 719-725
        • Lewis-Jones M.S.
        • Finlay A.Y.
        The Children's Dermatology Life Quality Index (CDLQI): initial validation and practical use.
        Br J Dermatol. 1995; 132: 942-949
        • Chamlin S.L.
        • Cella D.
        • Frieden I.J.
        • et al.
        Development of the childhood atopic dermatitis impact scale: initial validation of a quality-of-life measure for young children with atopic dermatitis and their families.
        J Invest Dermatol. 2005; 125: 1106-1111
        • McKenna S.P.
        • Whalley D.
        • Dewar A.L.
        • et al.
        International development of the Parents' Index of Quality of Life in Atopic Dermatitis (PIQoL-AD).
        Qual Life Res. 2005; 14: 231-241
        • Meads D.M.
        • McKenna S.P.
        • Kahler K.
        The quality of life of parents of children with atopic dermatitis: interpretation of PIQoL-AD scores.
        Qual Life Res. 2005; 14: 2235-2245
        • Drake L.
        • Prendergast M.
        • Maher R.
        • et al.
        The impact of tacrolimus ointment on health-related quality of life of adult and pediatric patients with atopic dermatitis.
        J Am Acad Dermatol. 2001; 44: S65-S72
        • Whalley D.
        • Huels J.
        • McKenna S.P.
        • et al.
        The benefit of pimecrolimus (Elidel, SDZ ASM 981) on parents' quality of life in the treatment of pediatric atopic dermatitis.
        Pediatrics. 2002; 110: 1133-1136
        • Krol A.
        • Krafchik B.
        The differential diagnosis of atopic dermatitis in childhood.
        Dermatol Ther. 2006; 19: 73-82
        • Leung A.K.C.
        • Robson W.L.M.
        Psoriasis.
        Consultant. 2005; 45: 578-579
        • Leung A.K.C.
        • Robson W.L.M.
        Nummular eczema: an overview.
        Consultant Pediatrician. 2006; 5: 790-793
        • Leung A.K.C.
        • Martin S.
        Drug therapy for some common pediatric skin eruptions.
        Drug Protocol. 1987; 2: 9-20
        • Hon K.L.E.
        • Lam M.C.A.
        • Leung T.F.
        • et al.
        Clinical features associated with nasal Staphylococcus aureus colonization in Chinese children with moderate-to-severe atopic dermatitis.
        Ann Acad Med Singap. 2005; 34: 602-605
        • Sidbury R.
        • Poorsattar S.
        Pediatric atopic dermatitis: should we treat it differently?.
        Dermatol Ther. 2006; 19: 83-90
        • Chamlin S.L.
        • Frieden I.J.
        • Williams M.L.
        • et al.
        Effects of atopic dermatitis on young American children and their families.
        Pediatrics. 2004; 114: 607-611
        • Dennis H.
        • Rostill H.
        • Reed J.
        • et al.
        Factors promoting psychological adjustment to childhood atopic eczema.
        J Child Health Care. 2006; 10: 126-139
        • Hon K.L.E.
        • Leung T.F.
        • Ma K.C.
        • et al.
        Resting energy expenditure, oxygen consumption and carbon dioxide production during deep in children with atopic dermatitis.
        J Dermatolog Treat. 2005; 16: 22-25
        • Carroll C.L.
        • Balkrishnan R.
        • Feldman S.R.
        • et al.
        The burden of atopic dermatitis: impact on the patient, family, and society.
        Pediatr Dermatol. 2005; 22: 192-199
        • Chamlin S.L.
        The psychosocial burden of childhood atopic dermatitis.
        Dermatol Ther. 2006; 19: 104-107
        • Kiebert G.
        • Sorensen S.V.
        • Revicki D.
        • et al.
        Atopic dermatitis is associated with a decrement in health-related quality of life.
        Int J Dermatol. 2002; 41: 151-158
        • Taïeb A.
        Allergy workup: when and how for the child with atopic dermatitis?.
        Acta Derm Venereol. 2005; 215: 16-20
        • Bingham E.A.
        Guidelines to management of atopic dermatitis.
        in: Harper J. Oranje A. Prose N. Textbook of pediatric dermatology. 2nd edition. Blackwell Publishing, Oxford2006: 259-275
        • Boguniewicz M.
        • Schmid-Grendelmeier P.
        • Leung D.Y.M.
        Atopic dermatitis.
        J Allergy Clin Immunol. 2006; 118: 40-43
        • Opper F.H.
        • Burakoff R.
        Food allergy and intolerance.
        Gastroenterologist. 1993; 1: 211-220
        • Bock S.A.
        • Atkins F.M.
        Patterns of food hypersensitivity during sixteen years of double-blind, placebo-controlled food challenges.
        J Pediatr. 1990; 117: 561-567
        • Kerschenlohr K.
        • Darsow U.
        • Burgdorf W.H.C.
        • et al.
        Lessons from atopy patch testing in atopic dermatitis.
        Curr Allergy Asthma Rep. 2004; 4: 285-289
        • Beattie P.E.
        • Lewis-Jones M.S.
        Parental knowledge of topical therapies in the treatment of childhood atopic dermatitis.
        Clin Exp Dermatol. 2003; 28: 549-553
        • Hon K.L.E.
        • Kam W.Y.C.
        • Leung T.F.
        • et al.
        Steroid fears in children with eczema.
        Acta Paediatr. 2006; 95: 1451-1455
        • Zuberbier T.
        • Orlow S.J.
        • Paller A.S.
        • et al.
        Patient perspectives on the management of atopic dermatitis.
        J Allergy Clin Immunol. 2006; 118: 226-232
        • Staab D.
        • Diepgen T.L.
        • Fartasch M.
        • et al.
        Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial.
        BMJ. 2006; 332: 933-936
        • Sampson H.A.
        • McCaskill C.C.
        Food hypersensitivity and atopic dermatitis: evaluation of 113 patients.
        J Pediatr. 1985; 107: 669-675
        • Hon K.L.E.
        • Leung T.F.
        • Kam W.Y.C.
        • et al.
        Dietary restriction and supplementation in children with atopic eczema.
        Clin Exp Dermatol. 2006; 31: 187-191
        • Brostoff J.
        • Hawk L.J.
        Food allergy in children.
        Eur J Nutr. 1991; 45: S11-S15
        • Zeiger R.S.
        Prevention of food allergy in infancy.
        Ann Allergy. 1990; 65: 430-441
        • Hanifin J.M.
        • Cooper K.D.
        • Ho V.C.
        • et al.
        Guidelines of care for atopic dermatitis.
        J Am Acad Dermatol. 2004; 50: 391-404
        • Muraro A.
        • Dreborg S.
        • Halken S.
        • et al.
        Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
        Pediatr Allergy Immunol. 2004; 15: 291-307
        • Leung A.K.C.
        • Sauve R.S.
        Breast is best for babies.
        J Natl Med Assoc. 2005; 97: 1010-1019
        • Simpson E.L.
        Atopic dermatitis prevention.
        Dermatol Ther. 2006; 19: 108-117
        • Von Berg A.
        • Koletzko S.
        • Grübl A.
        • et al.
        The effect of hydrolyzed cow's milk formula for allergy prevention in the first year of life: the German Infant Nutritional Intervention Study, a randomized double-blind trial.
        J Allergy Clin Immunol. 2003; 111: 533-540
        • Kramer M.S.
        • Kakuma R.
        Maternal dietary antigen avoidance during pregnancy and/or lactation for preventing or treating atopic disease in the child.
        in: The cochrane library. Issue 4. John Wiley & Sons, Chichester (UK)2004
        • Hon K.L.E.
        • Leung T.F.
        • Wong Y.
        • et al.
        A survey of bathing and showering practices in children with atopic eczema.
        Clin Dermatol. 2005; 30: 351-354
        • Lucky A.W.
        • Leach A.D.
        • Laskarzewski P.
        • et al.
        Use of an emollient as a steroid-sparing agent in the treatment of mild to moderate atopic dermatitis in children.
        Pediatr Dermatol. 1997; 14: 321-324
        • Chamlin S.L.
        • Frieden I.J.
        • Fowler A.
        • et al.
        Ceramide-dominant, barrier-repair lipids improve childhood atopic dermatitis.
        Arch Dermatol. 2001; 137: 1110-1112
        • Almawi W.Y.
        • Melemedjian O.K.
        Molecular mechanisms of glucocorticoid antiproliferative effects: antagonism of transcription factors activity by glucocorticoid receptor.
        J Leukoc Biol. 2002; 71: 9-15
        • Alomar A.
        • Berth-Jones J.
        • Bos J.D.
        • et al.
        The role of topical calcineurin inhibitors in atopic dermatitis.
        Br J Dermatol. 2004; 151: 3-27
        • Lebwohl M.
        A comparison of once-daily application of mometasone furoate 0.1% cream compared with twice-daily hydrocortisone valerate 0.2% cream in pediatric atopic dermatitis patients who failed to respond to hydrocortisone: mometasone furoate study group.
        Int J Dermatol. 1999; 38: 604-606
        • Wolkerstorfer A.
        • Strobos M.A.
        • Glazenburg E.J.
        • et al.
        Fluticasone propionate 0.05% cream once daily versus clobetasone butyrate 0.05% cream twice daily in children with atopic dermatitis.
        J Am Acad Dermatol. 1998; 39: 226-231
        • Kang S.
        • Lucky A.W.
        • Pariser D.
        • et al.
        Long-term safety and efficacy of tacrolimus ointment for the treatment of atopic dermatitis in children.
        J Am Acad Dermatol. 2001; 44: S58-S64
        • Bekersky I.
        • Fitzsimmons W.
        • Tanase A.
        • et al.
        Nonclinical and early clinical development of tacrolimus ointment for the treatment of atopic dermatitis.
        J Am Acad Dermatol. 2001; 44: S17-S27
        • Reitamo S.
        • Rissanen J.
        • Remitz A.
        • et al.
        Tacrolimus ointment does not affect collagen synthesis: results of a single-center randomized trial.
        J Invest Dermatol. 1998; 111: 396-398
        • Allen B.R.
        Tacrolimus ointment: its place in the therapy of atopic dermatitis.
        J Allergy Clin Immunol. 2002; 109: 401-403
        • Hauk P.J.
        • Leung D.Y.
        Tacrolimus (FK 506): new treatment approach in superantigen-associated diseases like atopic dermatitis?.
        J Allergy Clin Immunol. 2001; 107: 391-392
        • Arkwright P.D.
        • Patel L.
        • Moran A.
        • et al.
        Atopic eczema is associated with delayed maturation of the antibody response to pneumococcal vaccine.
        Clin Exp Immunol. 2000; 122: 16-19
        • Stiehm E.R.
        • Roberts R.L.
        • Kaplan M.S.
        • et al.
        Pneumococcal seroconversion after vaccination in children with atopic dermatitis treated with tacrolimus ointment.
        J Am Acad Dermatol. 2005; 53: S206-S213
        • Bernard L.A.
        • Eichenfield L.F.
        Topical immunomodulators for atopic dermatitis.
        Curr Opin Pediatr. 2002; 14: 414-418
        • Wollenberg A.
        • Sharma S.
        • von Bubnoff D.
        • et al.
        Topical tacrolimus (FK506) leads to profound phenotypic and functional alterations of epidermal antigen-presenting dendritic cells in atopic dermatitis.
        J Allergy Clin Immunol. 2001; 107: 519-525
        • Caproni M.
        • Torchia D.
        • Antiga E.
        • et al.
        The effects of tacrolimus ointment on regulatory T lymphocytes in atopic dermatitis.
        J Clin Immunol. 2006; 26: 370-375
        • Grassberger M.
        • Baumrucker T.
        • Enz A.
        • et al.
        A novel anti-inflammatory drug, SDZ ASM 981, for the treatment of skin diseases: in vitro pharmacology.
        Br J Dermatol. 1999; 141: 24-73
        • Hultsch T.
        • Muller K.D.
        • Meingassner J.G.
        • et al.
        Ascomycin macrolactam derivative SDZ ASM 981 inhibits the release of granule-associated mediators and of newly synthesized cytokines in RBL 2H3 mast cells in an immunophilin-dependent manner.
        Arch Dermatol Res. 1998; 290: 501-507
        • Meingassner J.G.
        • Grassberger M.
        • Fahrngruber H.
        • et al.
        A novel anti-inflammatory drug, SDZ ASM 981, for the topical and oral treatment of skin diseases: in vivo pharmacology.
        Br J Dermatol. 1997; 137: 568-576
        • Iskedjian M.
        • Piwko C.
        • Shear N.H.
        • et al.
        Topical calcineurin inhibitors in the treatment of atopic dermatitis: a meta-analysis of current evidence.
        Am J Clin Dermatol. 2004; 5: 267-279
        • Ashcroft D.M.
        • Dimmock P.
        • Garside R.
        • et al.
        Efficacy and tolerability of topical pimecrolimus and tacrolimus in the treatment of atopic dermatitis: meta-analysis of randomised controlled trials.
        BMJ. 2005; 330: 516-525
        • Bigby M.
        Tacrolimus and pimecrolimus for atopic dermatitis: where do they fit in?.
        Arch Dermatol. 2006; 142: 1203-1205
        • Paller A.S.
        • Lebwohl M.
        • Fleischer Jr., A.B.
        • et al.
        Tacrolimus ointment is more effective than pimecrolimus cream with a similar safety profile in the treatment of atopic dermatitis: results from 3 randomized, comparative studies.
        J Am Acad Dermatol. 2005; 52: 810-822
        • Kempers S.
        • Boguniewicz M.
        • Carter E.
        • et al.
        A randomized investigator-blinded study comparing pimecrolimus cream 1% with tacrolimus ointment 0.03% in the treatment of pediatric patients with moderate atopic dermatitis.
        J Am Acad Dermatol. 2004; 51: 515-525
      1. Shaw JC. Atopic dermatitis (eczema). In: Rose RD, editor. UpToDate. Waltham (MA); 2006.

        • Carroll C.L.
        • Fleischer Jr., A.B.
        Tacrolimus: focusing on atopic dermatitis.
        Drugs Today. 2006; 42: 431-439
        • Fonacier L.
        • Spergel J.
        • Charlesworth E.N.
        • et al.
        Report of the Topical Calcineurin Task Force of the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology.
        J Allergy Clin Immunol. 2005; 115: 1249-1253
        • Leung A.K.C.
        • Wong B.E.
        • Chan P.Y.
        • et al.
        Pruritus in children.
        J R Soc Health. 1998; 118: 280-286
        • Gauger A.
        Silver-coated textiles in the therapy of atopic eczema.
        Curr Probl Dermatol. 2006; 33: 152-164
        • Haug S.
        • Roll A.
        • Schmid-Grendelmeier P.
        • et al.
        Coated textiles in the treatment of atopic dermatitis.
        Curr Probl Dermatol. 2006; 33: 144-151
        • Juenger M.
        • Ladwig A.
        • Staecker S.
        • et al.
        Efficacy and safety of silver textile in the treatment of atopic dermatitis (AD).
        Curr Med Res Opin. 2006; 22: 739-750
        • Ricci G.
        • Patrizi A.
        • Bellini F.
        • et al.
        Use of textiles in atopic dermatitis.
        Curr Probl Dermatol. 2006; 33: 127-143
        • Barham K.L.
        • Yosipovitch G.
        It's a wrap: the use of wet pajamas in wet-wrap dressings for atopic dermatitis.
        Dermatol Nurs. 2005; 17: 365-367
        • Devillers A.C.A.
        • Oranje A.P.
        Efficacy and safety of ‘wet-wrap’ dressings as an intervention treatment in children with severe and/or refractory atopic dermatitis: a critical review of the literature.
        Br J Dermatol. 2006; 154: 579-585
        • Hessle C.
        • Hanson LÅ
        • Wold A.E.
        Lactobacilli from human gastrointestinal mucosa are strong stimulators of IL-12 production.
        Clin Exp Immunol. 1999; 116: 276-282
        • Kirjavainen P.V.
        • Apostolou E.
        • Salminen S.J.
        • et al.
        New aspects of probiotics – a novel approach in the management of food allergy.
        Allergy. 1999; 54: 909-915
        • Paganelli R.
        • Ciuffreda S.
        • Verna N.
        • et al.
        Probiotics and food-allergic diseases.
        Allergy. 2002; 57: 97-99
        • Williams H.C.
        Two “positive” studies of probiotics for atopic dermatitis—or are they?.
        Arch Dermatol. 2006; 142: 1201-1203
        • Kalliomäki M.
        • Salminen S.
        • Arvilommi H.
        • et al.
        Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial.
        Lancet. 2001; 357: 1076-1079
        • Kalliomäki M.
        • Salminen S.
        • Poussa T.
        • et al.
        Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial.
        Lancet. 2003; 361: 1869-1871
        • Lodinová-Zádníková R.
        • Cukrowska B.
        • Tlaskalova-Hogenova H.
        Oral administration of probiotic Escherichia coli after birth reduces frequency of allergies and repeated infections later in life (after 10 and 20 years).
        Int Arch Allergy Immunol. 2003; 131: 209-211
        • Rosenfeldt V.
        • Benfeldt E.
        • Nielsen S.D.
        • et al.
        Effect of probiotic lactobacillus strains in children with atopic dermatitis.
        J Allergy Clin Immunol. 2003; 111: 389-395
        • Viljanen M.
        • Savilahti E.
        • Haahtela T.
        • et al.
        Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial.
        Allergy. 2005; 60: 494-500
        • Weston S.
        • Halbert A.
        • Richmond P.
        • et al.
        Effects of probiotics on atopic dermatitis: a randomised controlled trial.
        Arch Dis Child. 2005; 90: 892-897
        • Passeron T.
        • Lacour J.P.
        • Fontas E.
        • et al.
        Prebiotics and synbiotics: two promising approaches for the treatment of atopic dermatitis in children above 2 years.
        Allergy. 2006; 61: 431-437
        • Capella G.L.
        • Grigerio E.
        • Altomare G.
        A randomized trial of leukotriene receptor antagonist montelukast in moderate-to-severe atopic dermatitis of adults.
        Eur J Dermatol. 2001; 11: 209-213
        • Hon K.L.E.
        • Leung T.F.
        • Ma K.C.
        • et al.
        Brief case series: Montelukast, at doses recommended for asthma treatment, reduces disease severity and increases soluble CD14 in children with atopic dermatitis.
        J Dermatolog Treat. 2005; 16: 15-18
        • Pei A.Y.S.
        • Chan H.H.L.
        • Leung T.F.
        Montelukast in the treatment of children with moderate-to-severe atopic dermatitis: a pilot study.
        Pediatr Allergy Immunol. 2001; 12: 154-158
        • Yanase D.J.
        • David-Bajar K.
        The leukotriene antagonist montelukast as a therapeutic agent for atopic dermatitis.
        J Am Acad Dermatol. 2001; 44: 89-93
        • Czarnecka-Operacz M.
        • Silny W.
        Specific immunotherapy in atopic dermatitis.
        Acta Dermatovenerol Croat. 2006; 14: 52-59
        • Werfel T.
        • Breuer K.
        • Rueff F.
        • et al.
        Usefulness of specific immunotherapy in patients with atopic dermatitis and allergic sensitization to house dust mites: a multi-centre, randomized, dose-response study.
        Allergy. 2006; 61: 202-205
        • Glover M.T.
        • Atherton D.J.
        A double-blind controlled trial of hyposensitization to Dermatophagoides pteronyssinus in children with atopic eczema.
        Clin Exp Allergy. 1992; 22: 440-446
        • Mastrandrea F.
        The potential role of allergen-specific sublingual immunotherapy in atopic dermatitis.
        Am J Clin Dermatol. 2004; 5: 281-294
        • Hon K.L.E.
        • Leung T.F.
        • Wong Y.
        • et al.
        A pentaherbs capsule as a treatment option for atopic dermatitis in children: an open-labeled case series.
        Am J Clin Med. 2004; 32: 941-950
      2. Hon KLE, Leung TF, Ng PC, et al. Efficacy and tolerability of a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized, double-blind, placebo-controlled study. Br J Dermatol, in press.

        • Sheehan M.P.
        • Atherton D.J.
        One-year follow up of children treated with Chinese medicinal herbs for atopic eczema.
        Br J Dermatol. 1994; 130: 488-493
        • Ramsay H.M.
        • Goddard W.
        • Gill S.
        • et al.
        Herbal creams used for atopic eczema in Birmingham, UK illegally contain potent corticosteroids.
        Arch Dis Child. 2003; 88: 1056-1057
        • Perharic L.
        • Shaw D.
        • Leon C.
        • et al.
        Possible association of liver damage with the use of Chinese herbal medicine for skin disease.
        Vet Hum Toxicol. 1995; 37: 562-566
        • Hon E.K.L.
        • Lee V.W.Y.
        • Leung T.F.
        • et al.
        Corticosteroids are not present in a traditional Chinese medicine formulation for atopic dermatitis in children.
        Ann Acad Med Singap. 2006; 35: 759-763
        • Rasmussen J.E.
        Advances in nondietary management of children with atopic dermatitis.
        Pediatr Dermatol. 1989; 6: 210-215
        • Takwale A.
        • Tan E.
        • Agarwal S.
        • et al.
        Efficacy and tolerability of borage oil in adults and children with atopic eczema: randomised, double blind, placebo controlled, parallel group trial.
        BMJ. 2003; 13: 1385-1389
        • Henz B.M.
        • Jablonska S.
        • van de Kerkhof P.C.
        • et al.
        Double-blind, multicenter analysis of the efficacy of borage oil in patients with atopic eczema.
        Br J Dermatol. 1999; 140: 685-688
        • Williams H.C.
        Atopic dermatitis.
        N Engl J Med. 2005; 352: 2314-2324