Difference between revisions of "Atopic dermatitis"

(Background)
(Management)
 
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==Background==
 
==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.
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*Also known as atopic eczema
 
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*A chronic type of inflammatory skin disease affecting many children and adults
*Must distinguish from [[Seborrheic Dermatitis]]
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*Occasionally accompanied by [[asthma]] and/or hay fever. Patients develop a cutaneous hyperreactivity to environmental triggers.  
**Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
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*Cause is not known, but believed to be due to an interaction between susceptibility genes, the environment, defective skin barrier function, and immunologic responses.
**Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
 
  
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==Clinical Features==
 
[[File:Atopic dermatitits.jpg|200px|thumb]]
 
[[File:Atopic dermatitits.jpg|200px|thumb]]
 
==Clinical Features==
 
 
*Atopic personal or family history, worse in winter, dry weather
 
*Atopic personal or family history, worse in winter, dry weather
*Erythema, crusts, fissures, pruritis, excoriations, lichenification
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*Erythema, crusts, fissures, [[pruritus]], excoriations, lichenification
  
 
===Infantile===
 
===Infantile===
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*Face, scalp, extremities
 
*Face, scalp, extremities
 
*1st few months of life, resolving by age 2
 
*1st few months of life, resolving by age 2
*Differentiate from impetigo (which may occur alongside)
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*Differentiate from [[impetigo]] (which may occur alongside)
  
 
===Adults===
 
===Adults===
*Dryness, thickening in AC and popliteal fossa, neck
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*Dryness, thickening in antecubital and popliteal fossae, neck
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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**Dry skin, erythematous papular lesions
 
**Dry skin, erythematous papular lesions
 
**Face most commonly involved; nose and diaper areas spared
 
**Face most commonly involved; nose and diaper areas spared
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 +
{{Neonatal atopic dermatitis vs seborrhoeic dermatitis}}
  
 
==Management==
 
==Management==
*Identify and eliminate triggers
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*Identify and eliminate triggers:
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**Alcohol based products
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**Fragrances and astringents
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**Excessive bathing
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**Allergens
 
*Reduce drying of skin
 
*Reduce drying of skin
*Liberal application of emollients (vaseline)
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**Avoid lotions (high water and low oil content)
*Triamcinolone, hydrocortisone, or betamethasone
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*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>
*Avoid fluoridinated steroids to the face
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**Alternatives include petroleum jelly and Aquaphor
*Consider [[doxepin]] for recalcitrant pruritis<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>
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**If using steroids, apply emollients on top of steroids
**25-50mg PO qhs
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*Topical steroids
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**7 days of low or medium potency steroid ointments either daily or BID
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***[[Triamcinolone]], [[hydrocortisone]], or [[betamethasone]]
 +
**Severe flares require high potency steroids followed by a taper
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***[[Topical steroid potency]] for additional options
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*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>
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**25-50mg PO nightly
 
**Or topical doxepin cream 5% QID
 
**Or topical doxepin cream 5% QID
  
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==Complications==
 
==Complications==
*Secondary bacterial infection
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*Secondary [[Skin and soft tissue infections|bacterial infection]]
 
*[[Eczema herpeticum]], widespread HSV infection
 
*[[Eczema herpeticum]], widespread HSV infection
 
*[[Dyshidrotic eczema]]
 
*[[Dyshidrotic eczema]]
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==See Also==
 
==See Also==
 
*[[Neonatal Rashes]]
 
*[[Neonatal Rashes]]
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*[[General approach to rashes]]
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*[[Pediatric rashes]]
  
 
==References==
 
==References==

Latest 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).