Difference between revisions of "Atopic dermatitis"

(Management)
 
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==Background==
 
==Background==
*Also know as atopic eczema
+
*Also known as atopic eczema
 
*A chronic type of inflammatory skin disease affecting many children and adults
 
*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.  
+
*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.
 
*Cause 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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[[File:Atopic dermatitits.jpg|200px|thumb]]
 
[[File:Atopic dermatitits.jpg|200px|thumb]]
 
*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
+
*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)
+
*Differentiate from [[impetigo]] (which may occur alongside)
  
 
===Adults===
 
===Adults===
*Dryness, thickening in AC and popliteal fossa, neck
+
*Dryness, thickening in antecubital and popliteal fossae, neck
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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**Face most commonly involved; nose and diaper areas spared
 
**Face most commonly involved; nose and diaper areas spared
  
===Distinguish from [[Seborrheic Dermatitis]]===
+
{{Neonatal atopic dermatitis vs seborrhoeic dermatitis}}
*Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
 
*Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
 
  
 
==Management==
 
==Management==
*Identify and eliminate triggers
+
*Identify and eliminate triggers:
 +
**Alcohol based products
 +
**Fragrances and astringents
 +
**Excessive bathing
 +
**Allergens
 
*Reduce drying of skin
 
*Reduce drying of skin
*Liberal application of emollients (vaseline)
+
**Avoid lotions (high water and low oil content)
*Triamcinolone, hydrocortisone, or betamethasone
+
*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
+
**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>
+
**If using steroids, apply emollients on top of steroids
**25-50mg PO qhs
+
*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
 
**Or topical doxepin cream 5% QID
  
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==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]]
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==See Also==
 
==See Also==
 
*[[Neonatal Rashes]]
 
*[[Neonatal Rashes]]
 +
*[[General approach to rashes]]
 +
*[[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).