Atopic dermatitis: Difference between revisions
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[[File:Atopic dermatitits.jpg|200px|thumb]] | [[File:Atopic dermatitits.jpg|200px|thumb]] | ||
==Clinical | ==Clinical Features== | ||
*Atopic personal or family hx, worse in winter, dry weather | *Atopic personal or family hx, worse in winter, dry weather | ||
*Erythema, crusts, fissures, pruritis, excoriations, lichenification | *Erythema, crusts, fissures, pruritis, excoriations, lichenification | ||
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===Adults=== | ===Adults=== | ||
*Dryness, thickening in AC and popliteal fossa, neck | *Dryness, thickening in AC and popliteal fossa, neck | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Neonatal rashes DDX}} | {{Neonatal rashes DDX}} | ||
== | ==Diagnosis== | ||
* | *Clinical diagnosis | ||
* | **Dry skin, erythematous papular lesions | ||
* | **Face most commonly involved; nose and diaper areas spared | ||
==Treatment== | ==Treatment== | ||
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**25-50 mg PO qhs | **25-50 mg PO qhs | ||
**Or topical doxepin cream 5% QID | **Or topical doxepin cream 5% QID | ||
==Disposition== | |||
*Outpatient | |||
==Complications== | |||
*Secondary bacterial infection | |||
*[[Eczema herpeticum]], widespread HSV infection | |||
*[[Dyshidrotic eczema]] | |||
==See Also== | ==See Also== | ||
Revision as of 07:32, 9 June 2016
Background
- Must distinguish from Seborrheic Dermatitis
- Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
- Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
Clinical Features
- Atopic personal or family hx, worse in winter, dry weather
- Erythema, crusts, fissures, pruritis, 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 AC and popliteal fossa, 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
Diagnosis
- Clinical diagnosis
- Dry skin, erythematous papular lesions
- Face most commonly involved; nose and diaper areas spared
Treatment
- Identify and eliminate triggers
- Reduce drying of skin
- Liberal application of emollients (vaseline)
- Triamcinolone, hydrocortisone, or betamethasone
- Avoid fluoridinated steroids to the face
- Consider doxepin for recalcitrant pruritis[1][2]
- 25-50 mg PO qhs
- Or topical doxepin cream 5% QID
Disposition
- Outpatient
Complications
- Secondary bacterial infection
- Eczema herpeticum, widespread HSV infection
- Dyshidrotic eczema