Atopic dermatitis

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 history, 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

Evaluation

• Clinical diagnosis
  • Dry skin, erythematous papular lesions
  • Face most commonly involved; nose and diaper areas spared

Management

• 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
  • 25-50mg PO qhs
  • Or topical doxepin cream 5% QID

Disposition

• Outpatient

Complications

• Secondary bacterial infection
• Eczema herpeticum, widespread HSV infection
• Dyshidrotic eczema

See Also

• Neonatal Rashes