Atopic dermatitis: Difference between revisions
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*Liberal application of emollients (vaseline) | *Liberal application of emollients (vaseline) | ||
*[[Triamcinolone]], [[hydrocortisone]], or [[betamethasone]] | *[[Triamcinolone]], [[hydrocortisone]], or [[betamethasone]] | ||
*[[Topical steroid potency]] for additional options | |||
*Avoid fluoridinated steroids to the face | *Avoid fluoridinated steroids to the face | ||
*Consider [[doxepin]] for recalcitrant pruritus<ref>Hercogova J. Topical anti-itch therapy. Dermatol Ther 18(4):341-3 (2005 Jul-Aug).</ref><ref>Drake L, Cohen L, Gillies R, et al. Pharmakinetics of doxepin in subjects with pruritic atopic dermatitis. J Am Acad Dermatol 41(2):209-14 (1999 Aug).</ref> | *Consider [[doxepin]] for recalcitrant pruritus<ref>Hercogova J. Topical anti-itch therapy. Dermatol Ther 18(4):341-3 (2005 Jul-Aug).</ref><ref>Drake L, Cohen L, Gillies R, et al. Pharmakinetics of doxepin in subjects with pruritic atopic dermatitis. J Am Acad Dermatol 41(2):209-14 (1999 Aug).</ref> | ||
Revision as of 03:27, 30 May 2017
Background
- Also known as atopic eczema
- A chronic type of inflammatory skin disease affecting many children and adults
- Occasionally accompanied by asthma and/or hay fever. Patients develop a cutaneous hyperreactivity to environmental triggers.
- Cause is not known, but believed to be due to an interaction between susceptibility genes, the environment, defective skin barrier function, and immunologic responses.
Clinical Features
- Atopic personal or family history, worse in winter, dry weather
- Erythema, crusts, fissures, pruritus, excoriations, lichenification
Infantile
- blisters, crusts, exfoliations
- Face, scalp, extremities
- 1st few months of life, resolving by age 2
- Differentiate from impetigo (which may occur alongside)
Adults
- Dryness, thickening in antecubital and popliteal fossae, neck
Differential Diagnosis
Neonatal Rashes
- Acne
- Atopic dermatitis
- Candidiasis
- Contact dermatitis
- Diaper dermatitis
- Erythema toxicum neonatorum
- Impetigo
- Mastitis
- Milia
- Miliaria
- Mongolian spots
- Omphalitis
- Perianal streptococcal dermatitis
- Psoriasis
- Pustular melanosis
- Seborrheic dermatitis
- Sucking blisters
- Tinea capitis
Evaluation
- Clinical diagnosis
- Dry skin, erythematous papular lesions
- Face most commonly involved; nose and diaper areas spared
Neonatal atopic dermatitis vs. seborrhoeic dermatitis
| Category | Neonatal atopic dermatitis | Neonatal seborrhoeic dermatitis |
| Presentation | 1-2 months | 2-6 months |
| Puritic (fussiness) | Yes | No |
Management
- Identify and eliminate triggers
- Reduce drying of skin
- Liberal application of emollients (vaseline)
- Triamcinolone, hydrocortisone, or betamethasone
- Topical steroid potency for additional options
- Avoid fluoridinated steroids to the face
- Consider doxepin for recalcitrant pruritus[1][2]
- 25-50mg PO nightly
- Or topical doxepin cream 5% QID
Disposition
- Outpatient
Complications
- Secondary bacterial infection
- Eczema herpeticum, widespread HSV infection
- Dyshidrotic eczema