Update on Atopic Eczema with Special Focus on Dryness and the Impact of Moisturizers

  • Eric Simpson


Atopic dermatitis (AD) is the most common skin disease of childhood and is characterized by erythematous papules and papulovesicles during its initial presentation, followed by subacute lesions that are crusted, weeping, scaling, and excoriated. Chronic lesions show skin thickening, xerosis, and exaggerated skin markings (lichenification) that are the skin’s response to rubbing (Fig. 16.1). Sites of predilection are the face and extensor extremities in infancy, with more frequent involvement of the flexural areas after age 1 [27]. Skin lesions are accompanied by intractable pruritus, the primary symptom leading to the reduced quality of life observed in these children.


Atopic Dermatitis Topical Steroid Skin Barrier Peanut Allergy Skin Barrier Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Akiyama M (2010) FLG mutations in ichthyosis vulgaris and atopic eczema: spectrum of mutations and population genetics. Br J Dermatol 162(3):472–477PubMedCrossRefGoogle Scholar
  2. 2.
    Barnes KC (2010) An update on the genetics of atopic dermatitis: scratching the surface in 2009. J Allergy Clin Immunol 125(1):16–29PubMedCrossRefGoogle Scholar
  3. 3.
    Berth-Jones J, Damstra RJ, Golsch S, Livden JK, Van Hooteghem O, Allegra F, Parker CA, Group MS (2003) Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study. Br Med J 326(7403):1367CrossRefGoogle Scholar
  4. 4.
    Bisgaard H, Simpson A, Palmer CN, Bønnelykke K, McLean I, Mukhopadhyay S, Pipper CB, Halkjaer LB, Lipworth B, Hankinson J, Woodcock A, Custovic A (2008) Gene-environment interaction in the onset of eczema in infancy: filaggrin loss-of-function mutations enhanced by neonatal cat exposure. PLoS Med 5(6):e131PubMedCrossRefGoogle Scholar
  5. 5.
    Bleck O, Abeck D, Ring J, Hoppe U, Vietzke JP, Wolber R, Brandt O, Schreiner V (1999) Two ceramide subfractions detectable in Cer(AS) position by HPTLC in skin surface lipids of non-lesional skin of atopic eczema. J Invest Dermatol 113(6):894–900PubMedCrossRefGoogle Scholar
  6. 6.
    Böhme M, Svensson A, Kull I, Wahlgren CF (2000) Hanifin’s and Rajka’s minor criteria for atopic dermatitis: which do 2-year-olds exhibit? J Am Acad Dermatol 43(5 Pt 1):785–792PubMedCrossRefGoogle Scholar
  7. 7.
    Brown SJ, Asai Y, Cordell HJ, Campbell LE, Zhao Y, Liao H, Northstone K, Henderson J, Alizadehfar R, Ben-Shoshan M, Morgan K, Roberts G, Masthoff LJ, Pasmans SG, van den Akker PC, Wijmenga C, Hourihane JO, Palmer CN, Lack G, Clarke A, Hull PR, Irvine AD, McLean WH (2011) Loss-of-function variants in the filaggrin gene are a significant risk factor for peanut allergy. J Allergy Clin Immunol 127(3):661–667PubMedCrossRefGoogle Scholar
  8. 8.
    Buraczewska I, Berne B, Lindberg M, Torma H, Loden M (2007) Changes in skin barrier function following long-term treatment with moisturizers, a randomized controlled trial. Br J Dermatol 156(3):492–498PubMedCrossRefGoogle Scholar
  9. 9.
    Chamlin SL, Kao J, Frieden IJ, Sheu MY, Fowler AJ, Fluhr JW, Williams ML, Elias PM (2002) Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: changes in barrier function provide a sensitive indicator of disease activity. J Am Acad Dermatol 47:198–208PubMedCrossRefGoogle Scholar
  10. 10.
    Chamlin SL (2006) The psychosocial burden of ­childhood atopic dermatitis. Dermatol Ther 19(2):104–107PubMedCrossRefGoogle Scholar
  11. 11.
    Cork MJ et al (2003) Comparison of parent knowledge, therapy utilization and severity of atopic eczema before and after explanation and demonstration of topical therapies by a specialist dermatology nurse. Br J Dermatol 149:582–589PubMedCrossRefGoogle Scholar
  12. 12.
    Darmstadt GL, Mao-Qiang M, Chi E, Saha SK, Ziboh VA, Black RE, Santosham M, Elias PM (2002) Impact of topical oils on the skin barrier: possible implications for neonatal health in developing countries. Acta Paediatr 91(5):546–554PubMedCrossRefGoogle Scholar
  13. 13.
    Darmstadt GL, Saha SK, Ahmed AS, Ahmed S, Chowdhury MA, Law PA, Rosenberg RE, Black RE, Santosham M (2008) Effect of skin barrier therapy on neonatal rates in preterm infants in Bangladesh: a randomized, controlled, clinical trial. Pediatrics 121(3):522–529PubMedCrossRefGoogle Scholar
  14. 14.
    Di Nardo A, Wertz P, Giannetti A, Seidenari S (1998) Ceramide and cholesterol composition of the skin of patients with atopic dermatitis. Acta Derm Venereol 78(1):27–30PubMedCrossRefGoogle Scholar
  15. 15.
    Eichenfield LF, Hanifin JM, Luger TA, Stevens SR, Pride HB (2003) Consensus conference on pediatric atopic dermatitis. J Am Acad Dermatol 49(6):1088–1095PubMedCrossRefGoogle Scholar
  16. 16.
    Elias PM, Feingold KR (2001) Does the tail wag the dog? Role of the barrier in the pathogenesis of inflammatory dermatoses and therapeutic implications. Arch Dermatol 137(8):1079–1081PubMedGoogle Scholar
  17. 17.
    Elias PM, Steinhoff M (2008) “Outside-to-inside” (and now back to “outside”) pathogenic mechanisms in atopic dermatitis. J Invest Dermatol 128(5):1067–1070PubMedCrossRefGoogle Scholar
  18. 18.
    Elias PM (2010) Therapeutic implications of a barrier-based pathogenesis of atopic dermatitis. Ann Dermatol 22(3):245–254PubMedCrossRefGoogle Scholar
  19. 19.
    Ellis C et al (2003) International Consensus Conference on Atopic Dermatitis II (ICCAD II): clinical update and current treatment strategies. Br J Dermatol 148(Suppl 63):3–10PubMedCrossRefGoogle Scholar
  20. 20.
    Fallon PG, Sasaki T, Sandilands A, Campbell LE, Saunders SP, Mangan NE, Callanan JJ, Kawasaki H, Shiohama A, Kubo A, Sundberg JP, Presland RB, Fleckman P, Shimizu N, Kudoh J, Irvine AD, Amagai M, McLean WH (2009) A homozygous frameshift mutation in the mouse FLG gene facilitates enhanced percutaneous allergen priming. Nat Genet 41(5):602–608PubMedCrossRefGoogle Scholar
  21. 21.
    Farwanah H, Raith K, Neubert RH, Wohlrab J (2005) Ceramide profiles of the uninvolved skin in atopic dermatitis and psoriasis are comparable to those of healthy skin. Arch Dermatol Res 296(11):514–521PubMedCrossRefGoogle Scholar
  22. 22.
    Flohr C, England K, Radulovic S, McLean WH, Campbel LE, Barker J, Perkin M, Lack G (2010) Filaggrin loss-of-function mutations are associated with early-onset eczema, eczema severity and transepidermal water loss at 3 months of age. Br J Dermatol 163(6):1333–1336PubMedCrossRefGoogle Scholar
  23. 23.
    Flohr C, Weiland SK, Weinmayr G, Bjorksten B, Braback L, Brunekreef B et al (2008) The role of atopic sensitization in flexural eczema: findings from the International Study of Asthma and Allergies in Childhood Phase Two. J Allergy Clin Immunol 121(1):141–147PubMedCrossRefGoogle Scholar
  24. 24.
    Ghadially R, Halkier-Sorensen L, Elias PM (1992) Effects of petrolatum on stratum corneum structure and function. J Am Acad Dermatol 26(3 Pt 2):387–396PubMedCrossRefGoogle Scholar
  25. 25.
    Gruber R, Elias PM, Crumrine D, Lin TK, Brandner JM, Hachem JP, Presland RB, Fleckman P, Janecke AR, Sandilands A, McLean WH, Fritsch PO, Mildner M, Tschachler E, Schmuth M (2011) Filaggrin genotype in ichthyosis vulgaris predicts abnormalities in epidermal structure and function. Am J Pathol 178(5):2252–2263PubMedCrossRefGoogle Scholar
  26. 26.
    Grunewald AM et al (1995) Damage to the skin by repetitive washing. Contact Dermatitis 32(4):225–232PubMedCrossRefGoogle Scholar
  27. 27.
    Halkjaer LB, Loland L, Buchvald FF, Agner T, Skov L, Strand M, Bisgaard H (2006) 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. Danish Pediatric Asthma Centre, Department of Pediatrics, Copenhagen University Hospital. Arch Dermatol 142(5):561–566PubMedCrossRefGoogle Scholar
  28. 28.
    Hanifin JM (2002) Atopiform dermatitis: do we need another confusing name for atopic dermatitis? Br J Dermatol 147(3):430–432PubMedCrossRefGoogle Scholar
  29. 29.
    Hanifin JM, Rajka G (1980) Diagnostic features of atopic dermatitis. Acta Dermatovener (Suppl) 92:44–47Google Scholar
  30. 30.
    Hanifin JM et al (2004) Guidelines of care for atopic dermatitis, developed in accordance with the American Academy of Dermatology (AAD)/American Academy of Dermatology Association “Administrative Regu­lations for Evidence-Based Clinical Practice Guidelines”. J Am Acad Dermatol 50(3):391–404PubMedCrossRefGoogle Scholar
  31. 31.
    Hatano Y, Katagiri K, Arakawa S, Fujiwara S (2007) Interleukin-4 depresses levels of transcripts for acid-sphingomyelinase and glucocerebrosidase and the amount of ceramide in acetone-wounded epidermis, as demonstrated in a living skin equivalent. J Dermatol Sci 47(1):45–47PubMedCrossRefGoogle Scholar
  32. 32.
    Held E, Sveinsdottir S, Agner T (1999) Effect of long-term use of moisturizer on skin hydration, barrier function and susceptibility to irritants. Acta Derm Venereol 79(1):49–51PubMedCrossRefGoogle Scholar
  33. 33.
    Herrick CA et al (2000) Th2 responses induced by epicutaneous or inhalational protein exposure are differentially dependent on IL-4. J Clin Invest 105:765–775PubMedCrossRefGoogle Scholar
  34. 34.
    Hoare C, Li Wan Po A, Williams H (2000) Systematic review of treatments for atopic eczema. Health Technol Assess 4(37):1–191PubMedGoogle Scholar
  35. 35.
    Howell MD, Novak N, Bieber T, Pastore S, Girolomoni G, Boguniewicz M, Streib J, Wong C, Gallo RL, Leung DY (2005) Interleukin-10 downregulates anti-microbial peptide expression in atopic dermatitis. J Invest Dermatol 125(4):738–745 (Erratum in: J Invest Dermatol (2005) 125(6):1320)Google Scholar
  36. 36.
    Howell MD, Kim BE, Gao P, Grant AV, Boguniewicz M, Debenedetto A, Schneider L, Beck LA, Barnes KC, Leung DY (2007) Cytokine modulation of atopic dermatitis filaggrin skin expression. J Allergy Clin Immunol 120(1):150–155PubMedCrossRefGoogle Scholar
  37. 37.
    Imokawa G, Abe A, Jin K, Higaki Y, Kawashima M, Hidano A (1991) Decreased level of ceramides in stratum corneum of atopic dermatitis: an etiologic factor in atopic dry skin? J Invest Dermatol 96(4):523–526PubMedCrossRefGoogle Scholar
  38. 38.
    Jensen JM, Pfeiffer S, Witt M, Bräutigam M, Neumann C, Weichenthal M, Schwarz T, Fölster-Holst R, Proksch E (2009) Different effects of pimecrolimus and betamethasone on the skin barrier in patients with atopic dermatitis. J Allergy Clin Immunol 124(3 Suppl 2):R19–R28PubMedCrossRefGoogle Scholar
  39. 39.
    Kezic S, O’Regan GM, Yau N, Sandilands A, Chen H, Campbell LE, Kroboth K, Watson R, Rowland M, Irwin McLean WH, Irvine AD (2011) Levels of filaggrin degradation products are influenced by both filaggrin genotype and atopic dermatitis severity. Allergy 66(7):934–940PubMedCrossRefGoogle Scholar
  40. 40.
    Lack G, Fox D, Northstone K, Golding J (2003) Avon Longitudinal Study of Parents and Children Study Team. Factors associated with the development of peanut allergy in childhood. N Engl J Med 348(11):977–985PubMedCrossRefGoogle Scholar
  41. 41.
    Leung R (1994) Asthma, allergy and atopy in South-east Asian immigrants in Australia. Aust N Z J Med 24(3):255–257PubMedCrossRefGoogle Scholar
  42. 42.
    Loden M, Andersson AC, Lindberg M (1999) Improvement in skin barrier function in patients with atopic dermatitis after treatment with a moisturizing cream (Canoderm). Br J Dermatol 140:264–267PubMedCrossRefGoogle Scholar
  43. 43.
    Loden M, Barany E (2000) Skin-identical lipids versus petrolatum in the treatment of tape-stripped and detergent-perturbed human skin. Acta Derm Venereol 80(6):412–415PubMedCrossRefGoogle Scholar
  44. 44.
    Lowe AJ, Abrahamson MJ, Hosking CS, Carlin JB, Bennett CM, Dharmage SC, Hill DJ (2007) The temporal sequence of allergic sensitization and onset of infantile eczema. Clin Exp Allergy 37:536–542PubMedCrossRefGoogle Scholar
  45. 45.
    Lucky AW, Leach AD, Laskarzewski P, Wenck H (1997) Use of an emollient as a steroid-sparing agent in the treatment of mild to moderate atopic dermatitis in children. Pediatr Dermatol 14:321–324PubMedCrossRefGoogle Scholar
  46. 46.
    Macharia WM, Anabwani GM, Owili DM (1991) Effects of skin contactants on evolution of atopic dermatitis in children: a case control study. Trop Doct 21(3):104–106PubMedGoogle Scholar
  47. 47.
    Miller DW, Koch SB, Yentzer BA, Clark AR, O’Neill JR, Fountain J, Weber TM, Fleischer AB Jr (2011) An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial. J Drugs Dermatol 10(5):531–537PubMedGoogle Scholar
  48. 48.
    Morgenstern V, Zutavern A, Cyrys J, Brockow I, Koletzko S, Krämer U, Behrendt H, Herbarth O, Von Berg A, Bauer CP, Wichmann HE, Heinrich J, GINI Study Group, LISA Study Group (2008) Atopic diseases, allergic sensitization, and exposure to traffic-related air pollution in children. Am J Respir Crit Care Med 177(12):1331–1337PubMedCrossRefGoogle Scholar
  49. 49.
    Murata Y, Ogata J, Higaki Y, Kawashima M, Yada Y, Higuchi K, Tsuchiya T, Kawainami S, Imokawa G (1996) Abnormal expression of sphingomyelin acylase in atopic dermatitis: an etiologic factor for ceramide deficiency? J Invest Dermatol 106(6):1242–1249PubMedCrossRefGoogle Scholar
  50. 50.
    O’Regan GM, Kemperman PM, Sandilands A, Chen H, Campbell LE, Kroboth K, Watson R, Rowland M, Puppels GJ, McLean WH, Caspers PJ, Irvine AD (2010) Raman profiles of the stratum corneum define 3 filaggrin genotype-determined atopic dermatitis endophenotypes. J Allergy Clin Immunol 126(3):574–580PubMedCrossRefGoogle Scholar
  51. 51.
    Odhiambo JA, Williams HC, Clayton TO, Robertson CF, Asher MI (2009) Global variations in prevalence of eczema symptoms in children from ISAAC phase three. J Allergy Clin Immunol 124(6):1251–1258PubMedCrossRefGoogle Scholar
  52. 52.
    Paller AS, Eichenfield LF, Kirsner RS, Shull T, Jaracz E, Simpson EL, US Tacrolimus Ointment Study Group (2008) Three times weekly tacrolimus ointment reduces relapse in stabilized atopic dermatitis: a new paradigm for use. Pediatrics 122(6):e1210–e1218PubMedCrossRefGoogle Scholar
  53. 53.
    Proksch E, Elias PM (2002) Epidermal barrier in atopic dermatitis. In: Bieber T, Leung DYM (eds) Atopic dermatitis. Marcel Dekker, Inc, New YorkGoogle Scholar
  54. 54.
    Rendell ME, Baig-Lewis SF, Berry TM, Denny ME, Simpson BM, Brown PA, Simpson EL (2011) Do early skin care practices alter the risk of atopic dermatitis? A case-control study. Ped Dermatol 28(5):593–595Google Scholar
  55. 55.
    Romanos M, Gerlach M, Warnke A, Schmitt J (2010) Association of attention-deficit/hyperactivity disorder and atopic eczema modified by sleep disturbance in a large population-based sample. J Epidemiol Community Health 64(3):269–273PubMedCrossRefGoogle Scholar
  56. 56.
    Sagransky MJ, Yentzer BA, Williams LL, Clark AR, Taylor SL, Feldman SR (2010) A randomized controlled pilot study of the effects of an extra office visit on adherence and outcomes in atopic dermatitis. Arch Dermatol 146(12):1428–1430PubMedCrossRefGoogle Scholar
  57. 57.
    Sandilands A, Sutherland C, Irvine AD, McLean WH (2009) Filaggrin in the frontline: role in skin barrier function and disease. J Cell Sci 122(Pt 9):1285–1294PubMedCrossRefGoogle Scholar
  58. 58.
    Scharschmidt TC, Man MQ, Hatano Y, Crumrine D, Gunathilake R, Sundberg JP, Silva KA, Mauro TM, Hupe M, Cho S, Wu Y, Celli A, Schmuth M, Feingold KR, Elias PM (2009) Filaggrin deficiency confers a paracellular barrier abnormality that reduces inflammatory thresholds to irritants and haptens. J Allergy Clin Immunol 124(3):496–506PubMedCrossRefGoogle Scholar
  59. 59.
    Schram ME, Leeflang MM, DEN Ottolander JP, Spuls PI, Bos JD (2011) Validation and refinement of the millennium criteria for atopic dermatitis. J Dermatol [epub ahead of print]Google Scholar
  60. 60.
    Schultz Larsen F, Hanifin JM (1992) Secular change in the occurrence of atopic dermatitis. Acta Derm Venereol (Stockh) 176(Suppl):7–12Google Scholar
  61. 61.
    Schuttelaar ML, Kerkhof M, Jonkman MF, Koppelman GH, Brunekreef B, de Jongste JC, Wijga A, McLean WH, Postma DS (2009) Filaggrin mutations in the onset of eczema, sensitization, asthma, hay fever and the interaction with cat exposure. Allergy 64(12):1758–1765PubMedCrossRefGoogle Scholar
  62. 62.
    Shaw TE, Currie GP, Koudelka C, Simpson EL (2010) Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health. J Invest Dermatol 131(1):67–73PubMedCrossRefGoogle Scholar
  63. 63.
    Simpson EL (2006) Atopic dermatitis prevention. Dermatol Ther 19(2):108–117PubMedCrossRefGoogle Scholar
  64. 64.
    Simpson EL (2010) Atopic dermatitis – a review of topical treatment options. Curr Med Res Opin 26(3):633–640PubMedCrossRefGoogle Scholar
  65. 65.
    Simpson EL, Berry TM, Brown PA, Hanifin JM (2010) A pilot study of emollient therapy for the primary prevention of atopic dermatitis. J Am Acad Dermatol 63(4):587–593PubMedCrossRefGoogle Scholar
  66. 66.
    Simpson EL, Dutronc Y (2011) A new body moisturizer increases skin hydration and improves atopic dermatitis symptoms among children and adults. J Drugs Dermatol 10(7):744–749Google Scholar
  67. 67.
    Soma Y, Kashima M, Imaizumi A, Takahama H, Kawakami T, Mizoguchi M (2005) Moisturizing effects of topical nicotinamide on atopic dry skin. Int J Dermatol 44(3):197–202PubMedCrossRefGoogle Scholar
  68. 68.
    Spergel JM, Mizoguchi E, Brewer JP, Martin TR, Bhan AK, Geha RS (1998) Epicutaneous sensitization with protein antigen induces localized allergic dermatitis and hyperresponsiveness to methacholine after single exposure to aerosolized antigen in mice. J Clin Invest 101:1614–1622PubMedCrossRefGoogle Scholar
  69. 69.
    Stücker M, Pieck C, Stoerb C, Niedner R, Hartung J, Altmeyer P (2004) Topical vitamin B12 – a new therapeutic approach in atopic dermatitis – evaluation of efficacy and tolerability in a randomized placebo-controlled multicentre clinical trial. Br J Dermatol 150(5):977–983PubMedCrossRefGoogle Scholar
  70. 70.
    Su JC, Kemp AS, Varigos GA, Nolan TM (1997) Atopic eczema: its impact on the family and financial cost. Arch Dis Child 76(2):159–162PubMedCrossRefGoogle Scholar
  71. 71.
    Suárez-Fariñas M, Tintle SJ, Shemer A, Chiricozzi A, Nograles K, Cardinale I, Duan S, Bowcock AM, Krueger JG, Guttman-Yassky E (2011) Nonlesional atopic dermatitis skin is characterized by broad terminal differentiation defects and variable immune abnormalities. J Allergy Clin Immunol 127(4):954–964PubMedCrossRefGoogle Scholar
  72. 72.
    Szczepanowska J, Reich A, Szepietowski JC (2008) Emollients improve treatment results with topical corticosteroids in childhood atopic dermatitis: a randomized comparative study. Pediatr Allergy Immunol 19(7):614–618PubMedCrossRefGoogle Scholar
  73. 73.
    Tagami H, Kobayashi H, O’goshi K, Kikuchi K (2006) Atopic xerosis: employment of noninvasive biophysical instrumentation for the functional analyses of the mildly abnormal stratum corneum and for the efficacy assessment of skin care products. J Cosmet Dermatol 5(2):140–149PubMedCrossRefGoogle Scholar
  74. 74.
    Thomas KS, Dean T, O’Leary C, Sach TH, Koller K, Frost A, Williams HC (2011) SWET Trial Team. A randomised controlled trial of ion-exchange water softeners for the treatment of eczema in children. PLoS Med 8(2):e1000395PubMedCrossRefGoogle Scholar
  75. 75.
    Thomsen SF, Ulrik CS, Kyvik KO, Hjelmborg JB, Skadhauge LR, Steffensen I, Backer V (2007) Importance of genetic factors in the etiology of atopic dermatitis: a twin study. Allergy Asthma Proc 28(5):535–539PubMedCrossRefGoogle Scholar
  76. 76.
    Tsai TF, Maibach HI (1999) How irritant is water? An overview. Contact Dermatitis 41(6):311–314PubMedGoogle Scholar
  77. 77.
    van den Oord RA, Sheikh A (2009) Filaggrin gene defects and risk of developing allergic sensitisation and allergic disorders: systematic review and meta-analysis. Br Med J 339:b2433. doi:  10.1136/bmj.b2433
  78. 78.
    van der Hulst AE, Klip H, Brand PL (2007) Risk of developing asthma in young children with atopic eczema: a systematic review. J Allergy Clin Immunol 120(3):565–569PubMedCrossRefGoogle Scholar
  79. 79.
    Wahn U, Bos JD, Goodfield M, Caputo R, Papp K, Manjra A, Dobozy A, Paul C, Molloy S, Hultsch T, Graeber M, Cherill R, de Prost Y (2002) Flare Reduction in Eczema with Elidel (Children) Multicenter Investigator Study Group. Efficacy and safety of pimecrolimus cream in the long-term management of atopic dermatitis in children. Pediatrics 110(1 Pt 1):e2PubMedCrossRefGoogle Scholar
  80. 80.
    Weidinger S, O’Sullivan M, Illig T, Baurecht H, Depner M, Rodriguez E, Ruether A, Klopp N, Vogelberg C, Weiland SK, McLean WH, von Mutius E, Irvine AD, Kabesch MJ (2008) Filaggrin mutations, atopic eczema, hay fever, and asthma in children. J Allergy Clin Immunol 121(5):1203–1209PubMedCrossRefGoogle Scholar
  81. 81.
    Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR (2008) Is eczema really on the increase worldwide? J Allergy Clin Immunol 121(4):947–954PubMedCrossRefGoogle Scholar
  82. 82.
    Woods MT, Brown PA, Baig-Lewis SF, Simpson EL (2011) Effects of a novel formulation of fluocinonide 0.1% cream on skin barrier function in atopic dermatitis. J Drugs Dermatol 10((2):171–176PubMedGoogle Scholar
  83. 83.
    Yaghmaie P, Koudelka CW, Simpson EL (2011) Psychiatric comorbidity in pediatric eczema. J Invest Dermatol 131(Suppl 1):41 (Abstract #246)Google Scholar
  84. 84.
    Yamamoto A, Serizawa S, Ito M, Sato Y (1991) Stratum corneum lipid abnormalities in atopic dermatitis. Arch Dermatol Res 283(4):219–223PubMedCrossRefGoogle Scholar
  85. 85.
    Yura A, Kouda K, Iki M, Shimizu T (2011) Trends of allergic symptoms in school children: large-scale long-term consecutive cross-sectional studies in Osaka Prefecture, Japan. Pediatr Allergy Immunol 5. doi: 10.1111/j.1399-3038.2011.01159.x[Epub ahead of print]

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of DermatologyOregon Health & Science University, Center for Health and HealingPortlandUSA

Personalised recommendations