Difference between revisions of "Atopic dermatitis"

(Background)
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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.
 
*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]]
+
==Clinical Features==
**Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
 
**Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
 
 
 
 
[[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
 
*Erythema, crusts, fissures, pruritis, excoriations, lichenification
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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
 +
 +
===Distinguish from [[Seborrheic Dermatitis]]===
 +
*Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
 +
*Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
  
 
==Management==
 
==Management==

Revision as of 01:35, 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.

Clinical Features

Atopic dermatitits.jpg
  • 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

Distinguish from Seborrheic Dermatitis

  • Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
  • Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)

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).