Atopic dermatitis: Difference between revisions

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==Background==
==Background==
*Must distinguish from [[Seborrheic Dermatitis]]
*Also known as atopic eczema
**Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
*A chronic type of inflammatory skin disease affecting many children and adults
**Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
*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==
[[File:Atopic dermatitits.jpg|200px|thumb]]
[[File:Atopic dermatitits.jpg|200px|thumb]]
*Atopic personal or family history, worse in winter, dry weather
*Erythema, crusts, fissures, [[pruritus]], excoriations, lichenification


==Clinical features==
===Infantile===
*Atopic personal or family hx, worse in winter, dry weather
*blisters, crusts, exfoliations
*Erythema, crusts, fissures, pruritis, excoriations, lichenification
*Face, scalp, extremities
*Infantile form - blisters, crusts, exfoliations
*1st few months of life, resolving by age 2
**Face, scalp, extremities
*Differentiate from [[impetigo]] (which may occur alongside)
**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


==Diagnosis==
===Adults===
*Dry skin, erythematous papular lesions
*Dryness, thickening in antecubital and popliteal fossae, neck
*Face most commonly involved; nose and diaper areas spared


==Differential Diagnosis==
==Differential Diagnosis==
{{Neonatal rashes DDX}}
{{Neonatal rashes DDX}}
==Evaluation==
*Clinical diagnosis
**Dry skin, erythematous papular lesions
**Face most commonly involved; nose and diaper areas spared
{{Neonatal atopic dermatitis vs seborrhoeic dermatitis}}
==Management==
*Identify and eliminate triggers:
**Alcohol based products
**Fragrances and astringents
**Excessive bathing
**Allergens
*Reduce drying of skin
**Avoid lotions (high water and low oil content)
*Liberal application of emollients (vaseline) immediately after bath (<5 min, skin should be pat dry instead of rubbing) <ref>Fang J. Dermatology. In: The Harriet Lane Handbook. 20th ed. Philadelphia, PA: Elsevier; 2015</ref>
**Alternatives include petroleum jelly and Aquaphor
**If using steroids, apply emollients on top of steroids
*Topical steroids
**7 days of low or medium potency steroid ointments either daily or BID
***[[Triamcinolone]], [[hydrocortisone]], or [[betamethasone]]
**Severe flares require high potency steroids followed by a taper
***[[Topical steroid potency]] for additional options
*Avoid fluoridinated steroids to thin skin areas such as face, groin, or axilla
*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>
**25-50mg PO nightly
**Or topical doxepin cream 5% QID
==Disposition==
*Outpatient


==Complications==
==Complications==
*Secondary bacterial infection
*Secondary [[Skin and soft tissue infections|bacterial infection]]
*[[Eczema herpeticum]], widespread HSV infection
*[[Eczema herpeticum]], widespread HSV infection
*[[Dyshidrotic eczema]]
*[[Dyshidrotic eczema]]
==Treatment==
*Identify and eliminate triggers
*Reduce drying of skin
*Liberal application of emollients (vaseline)
*Triamcinolone, hydrocortisone, or betamethasone
*Avoid fluoridinated steroids to the face


==See Also==
==See Also==
*[[Neonatal Rashes]]
*[[Neonatal Rashes]]
*[[General approach to rashes]]
*[[Pediatric rashes]]


==Sources==
==References==
*Kim BS et al. Atopic Dermatitis. eMedicine. Jul 1, 2015. http://emedicine.medscape.com/article/1049085-overview.
<references/>


[[Category:Derm]]
[[Category:Dermatology]]
[[Category:Peds]]
[[Category:Pediatrics]]

Revision as of 03:48, 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 dermatitits.jpg
  • 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

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:
    • Alcohol based products
    • Fragrances and astringents
    • Excessive bathing
    • Allergens
  • Reduce drying of skin
    • Avoid lotions (high water and low oil content)
  • Liberal application of emollients (vaseline) immediately after bath (<5 min, skin should be pat dry instead of rubbing) [1]
    • Alternatives include petroleum jelly and Aquaphor
    • If using steroids, apply emollients on top of steroids
  • Topical steroids
  • Avoid fluoridinated steroids to thin skin areas such as face, groin, or axilla
  • Consider doxepin for recalcitrant pruritus[2][3]
    • 25-50mg PO nightly
    • Or topical doxepin cream 5% QID

Disposition

  • Outpatient

Complications

See Also

References

  1. ↑ Fang J. Dermatology. In: The Harriet Lane Handbook. 20th ed. Philadelphia, PA: Elsevier; 2015
  2. ↑ Hercogova J. Topical anti-itch therapy. Dermatol Ther 18(4):341-3 (2005 Jul-Aug).
  3. ↑ 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).
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