Author:
Alan B. Fleischer, Jr., MD, Professor and Chair of Dermatology, Wake Forest University Health Sciences, Winston-Salem, NC

Introduction

This was the twentieth consecutive meeting of the American Academy of Dermatology that this reviewer has attended, and medical dermatology continues to be alive and well. Although there was an enormous amount of attention given to neurotoxins, filler substances, and ablative devices, medical therapeutics still constitutes a large proportion of the meeting. There were many intriguing presentations which provided new insights into atopic dermatitis (AD) and evidence for how clinicians should optimally treat patients. As many people know, AD is increasing worldwide in incidence. Although many suggest that the hygiene hypothesis holds sway, AD is a complex genetic and environmental condition. In presenting results from the 66^th Meeting of the American Academy of Dermatology, clinicians can glean understanding of new ways to counsel and treat their patients with optimal outcomes. Each study described below, represents this reviewer's opinion of the most important findings presented during the meeting.,

Atopic Eczema

During the Symposium on atopic eczema and other dermatitides, Dr. Gil Yosipovitch, Wake Forest University Health Sciences, Winston-Salem, NC, discussed factors related to the itch of AD.¹ Itch is the cardinal symptom of AD, so an attempt to understand this is critical. Keratinocytes bear receptors for opiates, nerve growth factor and other neural factors. Proteases can promote itch via PAR₂ receptors. NGF is involved in scratching and dry skin. Acute stress seems to raise NGF levels. Peripheral opiates seem to be important mediators. Mu and kappa opioids seem to be most related to the itch of AD.,

Quality of Life in Patients with Atopic Dermatitis

In the poster entitled "Atopic Dermatitis: Impact on the QOL of patients and patients' spouses," Dr. Charles Taieb, Pierre Fabre, Boulogne, France, and colleagues presented some intriguing results.² These investigators studied a population of adult patients (age > 18) from 6 European countries with mean age of 39±18, females 64%, and duration of AD mean 25±19 years. Instruments employed included the SCORAD (for assessing AD severity), DF12, DLQI, and Sexual Functioning Questionnaire. Spouses completed the SF12 and the Sexual Functioning Questionnaire. This was a severely effected group, with mean SCORAD of 45±12, and 26% had moderate AD, whereas 71% had severe AD. Patients with severe disease were found to have a higher DLQI than those with mild disease, indicating poorer QOL. The SF12 demonstrated that both mental and physical components were affected, and there was a high correlation (R = 0.66) between the mental component score of subjects with their spouses. AD also had an impact on sexual functioning in the majority of subjects including their sexual desire and effect on sex life due to physical appearance. Both subjects and their spouses (73%) expressed concern over their fear of transmitting the condition to their children, and this affected sex life as well. This important study finds that patients are greatly affected by AD, and that the QOL effect extends into the bedroom. It also established that AD patients and their spouses are concerned about transmission of the condition to their children. Thus, the impact of AD is more than skin deep.