Difference between revisions of "Atopic dermatitis"

(Text replacement - "==Treatment==" to "==Management==")
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*Avoid fluoridinated steroids to the face
 
*Avoid fluoridinated steroids to the face
 
*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>
 
*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>
**25-50 mg PO qhs
+
**25-50mg PO qhs
 
**Or topical doxepin cream 5% QID
 
**Or topical doxepin cream 5% QID
  

Revision as of 15:25, 19 July 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

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

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).