Triggers in atopic dermatitis/eczema : separating fact from fiction : review article

Atopic dermatitis/eczema (ADE) is a common condition affecting up to 20% of children in some countries. Atopic dermatitis/eczema impairs quality of life, not only of the patient, but also of family members. Due to the increasing prevalence noticed in westernised populations since the 1940s, particular attention should be paid to triggers, which may be contributing to this rise. Identifying a trigger is fraught with difficulty due to the fluctuating natural course of ADE. Triggers of ADE include irritants (such as soap and detergents), allergens (including standard patch test defined allergens, aeroallergens and food allergens), skin infections (such as Staphylococcus aureus, group A streptococci, herpes simplex virus, malassezia and tinea infections) and others, including cigarette smoke exposure and psychological stress. Many commonly believed triggers, such as extreme temperatures and exposure to sand, have meagre supporting evidence. Nevertheless, they may aggravate the disease. The literature dealing with triggers is sparse. In this article an overview will be given regarding the relevant literature dealing with this difficult topic.