Dry skin in childhood and the misery of eczema and its treatments

Abstract

Dry skin represents the earliest clinical sign of atopic eczema and is associated with underlying subclinical inflammatory changes. Complex gene-environment interactions in eczema lead to epidermal barrier dysfunction and immunopathological changes associated with allergic sensitisation. The epidermal protein filaggrin plays a key role in epidermal cell terminal differentiation and skin barrier integrity. Inheritance of loss-of-function filaggrin genes (FLG) causes ichthyosis vulgaris and carries an extremely high risk of developing severe, early-onset eczema often persisting into adult life. The impact on quality of life (QoL) caused by eczema is similar to that from other more serious systemic diseases, and QoL studies indicate that it greatly affects the psychosocial functioning of children and their family unit. The physical effects of itching, pain, sleep loss and exhaustion and the psychological stress from the practicalities of caring for eczema cause misery and interfere with a normal lifestyle. Lack of adherence to therapy has complex causes but is the main reason for poor disease control. Education and a good patient-physician relationship is the most successful way of encouraging good treatment adherence.