Atopic dermatitis
Background
Atopic dermatitis, also know as atopic eczema, is a chronic type of inflammatory skin disease affecting many children and adults. Occasionally accompanied by asthma and/or hay fever but not always. Patients develop a cutaneous hyperreactivity to environmental triggers. The cause of atopic dermatitis is not known but believed to be due to an interaction between susceptibility genes, the environment, defective skin barrier function, and immunologic responses.
- 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[1][2]
- 25-50mg PO qhs
- Or topical doxepin cream 5% QID
Disposition
- Outpatient
Complications
- Secondary bacterial infection
- Eczema herpeticum, widespread HSV infection
- Dyshidrotic eczema