Fall has arrived once again. This is the time of the year when the majority of patients suffer from Pruritus. Pruritus is more severe to patients already suffering with Atopic Dermatitis. The number of patients suffering from Atopic Dermatitis worldwide has been increasing up to a million. Meanwhile, I had the opportunity to meet with Professor Bok Yang Pyun, an Atopic Dermatitis Specialist at Soon Chun Hyang University Seoul Hospital, to discuss about the problems we face today.

Bok Yang Pyun, Professor, M.D., Ph.D.

Professor/Chief, Pediatric Allergy & Respiratory Center, Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
  • -Graduated from EWHA Woman’s University, School of Medicine
  • -Visiting Professor, Department of Pediatric Allergy, Tokyo Children’s Hospital, Tokyo, Japan
  • -Postdoctoral Fellowship, LA Childrens’ Hospital, University of Southern California, LA, CA, USA
  • -Member of Skin Committee, World Allergy Organization
  • -Secretary General of Korean Pediatric Society
  • -President of Korean Academy of Pediatric Allergy and Respiratory Diseases
  • -Chairman of Korean Academy of Pediatric Allergy and Respiratory Diseases

1. A lot of patients suffer from dry skin and Pruritus in Fall. What is the difference between Pruritus(Itch) and Atopic Dermatitis(AD)?
Pruritus(Itch) is regularly defined as an unpleasant sensation provoking the desire to scratch. Skin itch can be occurred in various causes, not only the allergic diseases such as atopic dermatitis(AD), urticaria, and contact dermatitis, but also other medical diseases (liver diseases, chronic renal diseases and diabetes mellitus, etc.).
AD is the most common chronic relapsing allergic skin disease seen in infancy and childhood. It affects 10-30% of children worldwide and frequently occurs in families with other allergic diseases, such as asthma, allergic rhinitis. Intense itch, especially at night and typical eczematous skin lesion are the cardinal features of AD. 

2. Is Atopic Dermatitis a curable disease?
Atopic dermatitis typically begins in infancy and approximately 50% of patients experience symptoms in the first year of life. Spontaneous resolution of atopic dermatitis has been reported to occur after age 5yr in 40-60% of patients affected during infancy, particularly for mild cases. Infants with atopic dermatitis are predisposed to development of allergic rhinitis and/or asthma later in childhood, a process called ‘the atopic march’.

3. Is there a way to prevent the occurrence of Atopic Dermatitis in infants aged 2-3 months?
Atopic Dermatitis typically occurs in people who have allergy. Unfortunetely, there has been an increase in the number of patients suffering from Atopic Dermatitis recently due to their diet, living conditions, and air pollution, and therefore focusing on ways to improve and manage these conditions has been one of the ways to prevent the disease.
Breastfeeding during the first 4 months after birth may be beneficial in high risk infants who have a family member with allergic diseases. Emollient therapy applied to the whole body for the first few months of life may enhance the cutaneous skin barrier and reduce the risk of eczema. Identification and elimination of triggering factors is the mainstay for prevention of eczema as well as for the long-term treatment of AD.

4. The number of adults in their 20s and 30s who suffer from Atopic Dermatitis is constantly increasing. Is there a reason as to why Atopic Dermatitis in adults tends to be considered more serious than that in children?
Atopic dermatitis in childhood has a chance to naturally outgrow as they get older. Approximately 80% of children outgrow their atopic dermatitis by adolescence, however approximately 20% of the patients persistently have their symptoms until adulthood. Many patients suffer from severe itch which has many difficulties in daily life, including sleep and emotional depression due to their skin lesion. Those difficulties may aggravate their symptoms and disturb the quality of life.

5. Atopic dermatitis most importantly requires continuous treatment. What are some treatments that can be done by patients at their homes?
The treatment of atopic dermatitis requires a multifaceted approach that incorporates skin hydration, topical and systemic pharmacological treatment, and identification and elimination of trigger factors. In healthy people, the skin acts as a protective barrier against external irritant, moisture loss, and infection. Most patients with AD have impaired skin barrier functions, which leads to excess skin water loss and causative materials penetration. Also patients with AD have increased susceptibility to bacterial, viral, and fungal skin infections. Therefore, restoration of impaired skin barrier is first-line therapy of atopic dermatitis. Sufficient skin hydration with appropriate manner is important to restore the skin barrier into a healthy state. 
It would be helpful to consult a specialist in the field when choosing the appropriate moisturizer best fit for each patient..

6. Any last words of advice for the million patients suffering from Atopic Dermatitis and their family?
Atopic Dermatitis can be well taken care of with constant treatment and care. Therefore, rather than relying on unverified methods of treatment, it is advisable to follow the principle and get proper treatment.
Relying on unverified methods of treatment may lead to anemia, malnutrition, and/or developmental disorder. Thus, please take extra caution.