Difference between revisions of "Atopic dermatitis"

(Background)
(Background)
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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 know as atopic eczema
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*A chronic type of inflammatory skin disease affecting many children and adults
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*Occasionally accompanied by asthma and/or hay fever. Patients develop a cutaneous hyperreactivity to environmental triggers.  
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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.
  
 
*Must distinguish from [[Seborrheic Dermatitis]]
 
*Must distinguish from [[Seborrheic Dermatitis]]

Revision as of 01:34, 15 August 2016

Background

  • Also know 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.
  • 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 history, 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

Evaluation

  • 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).