Immunological Atopic eczema

In AD increased S. aureus colonization plays a fundamental role therefore, antistaphylococcal therapy is part of a successful management of the disease. Epidermal lipid deficiencies and barrier dysfunction contribute to enhanced S. aureus attachment to the skin and mediate immunological and inflammatory effects including the release of superantigens, additional exotoxins, and exoenzymes, and perhaps bacterial DNA-triggered mechanisms. Therapeutic possibilities include the use of topical antiseptics in cases of microbial-laden atopic eczema, corticosteroids, and specific antibiotic-antiseptic combinations in cases of localized superinfected atopic eczema and systemic antibiotics in cases of generalized superinfected atopic eczema.48... 

Topical monoethyl fumarate caused contact dermatitis in a patient with atopic eczema and a generalized, partly pustulous, exanthema in a patient with psoriasis (10). The authors suggested that the mechanism was non-immunological contact urticaria. 

In contrast, strategies aimed at secondary prevention can be based on the early manifestation of the IgE-mediated disease or even disease preceding IgE sensitisation, which usually occurs during infancy. Potential interventions include allergen avoidance measures to induce tolerance and early immunotherapy. Data have been provided that the early administration of pharmacotherapy in infants who have already developed atopic eczema can attenuate the allergic march into asthma (see Chapter 3, Early Immunological Influences). 

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