Difference between revisions of "Atopic dermatitis"

(Adults)
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[[File:Atopic dermatitits.jpg|200px|thumb]]
 
[[File:Atopic dermatitits.jpg|200px|thumb]]
  
==Clinical features==
+
==Clinical Features==
 
*Atopic personal or family hx, worse in winter, dry weather
 
*Atopic personal or family hx, worse in winter, dry weather
 
*Erythema, crusts, fissures, pruritis, excoriations, lichenification
 
*Erythema, crusts, fissures, pruritis, excoriations, lichenification
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===Adults===
 
===Adults===
 
*Dryness, thickening in AC and popliteal fossa, neck
 
*Dryness, thickening in AC and popliteal fossa, neck
 
==Diagnosis==
 
*Dry skin, erythematous papular lesions
 
*Face most commonly involved; nose and diaper areas spared
 
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Neonatal rashes DDX}}
 
{{Neonatal rashes DDX}}
  
==Complications==
+
==Diagnosis==
*Secondary bacterial infection
+
*Clinical diagnosis
*[[Eczema herpeticum]], widespread HSV infection
+
**Dry skin, erythematous papular lesions
*[[Dyshidrotic eczema]]
+
**Face most commonly involved; nose and diaper areas spared
  
 
==Treatment==
 
==Treatment==
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**25-50 mg PO qhs
 
**25-50 mg PO qhs
 
**Or topical doxepin cream 5% QID
 
**Or topical doxepin cream 5% QID
 +
 +
==Disposition==
 +
*Outpatient
 +
 +
==Complications==
 +
*Secondary bacterial infection
 +
*[[Eczema herpeticum]], widespread HSV infection
 +
*[[Dyshidrotic eczema]]
  
 
==See Also==
 
==See Also==

Revision as of 07:32, 9 June 2016

Background

  • Must distinguish from Seborrheic Dermatitis
    • Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
    • Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
Atopic dermatitits.jpg

Clinical Features

  • Atopic personal or family hx, 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

Diagnosis

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

Treatment

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

Disposition

  • Outpatient

Complications

See Also

References

  1. Hercogova J. Topical anti-itch therapy. Dermatol Ther 18(4):341-3 (2005 Jul-Aug).
  2. 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).