Atopic dermatitis: diagnosis, treatment, and aeromedical implications.

Over the past 30 yr, the prevalence of atopic dermatitis (AD) has increased significantly in the general population. Given this increased burden of disease, more AD will be seen in civilian and military aviators. This article reviews the clinical aspects of AD with a focus on the aeromedical implications of the disease. The diagnosis of AD is mainly clinical. Treatment options are numerous, although topical corticosteroids are generally the mainstay of treatment. The new immunomodulators are options for treatment of AD and have advantages and disadvantages when compared with topical corticosteroids. These immunomodulators are discussed in detail with an emphasis on their mechanism of action, efficacy, side effect profile, and possible risks. The implications of AD in aviators and safety of flight are reviewed. Interference of the wearing of cockpit equipment, use of systemic or topical medications, and AD's association with the other diseases of atopy all contribute to whether an aviator is qualified to fly. Environmental triggers, such as temperature changes, sweating, humidity, bathing frequency, contact with irritating substances, and stress may exacerbate the aviator's disease. Special consideration should be given to the severity of their disease, the treatment the aviator requires, and the environment he or she will be working and living in before giving aeromedical clearance. Finally, the policies of each military service and experiences in civil aviation are discussed.