Atopic dermatitis: Difference between revisions

 
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==Background==
==Background==
*Must distinguish from [[Seborrheic Dermatitis]]
*Also known as atopic eczema
**Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
*A chronic type of inflammatory skin disease affecting many children and adults
**Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
*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.


[[File:Atopic dermatitits.jpg|200px|thumb]]
{{Dermatitis types}}


==Clinical features==
==Clinical Features==
*Atopic personal or family hx, worse in winter, dry weather
[[File:Atopic dermatitits.jpg|thumb|]]
*Erythema, crusts, fissures, pruritis, excoriations, lichenification
[[File:Atopy2010.jpg|thumb|Atopic dermatitis of the inside crease of the elbow.]]
*Infantile form - blisters, crusts, exfoliations
*Atopic personal or family history, worse in winter, dry weather
**Face, scalp, extremities
*Erythema, crusts, fissures, [[pruritus]], excoriations, lichenification
**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


==Diagnosis==
===Infantile===
*Dry skin, erythematous papular lesions
*blisters, crusts, exfoliations
*Face most commonly involved; nose and diaper areas spared
*Face, scalp, trunk, extensor surfaces, sparing of diaper area
*1st few months of life, resolving by age 2
*Differentiate from [[impetigo]] (which may occur alongside)
 
===Childhood===
*~4-12 years old
*Wrists, ankles, antecubital and popliteal fossae
 
===Adults===
*>12 years old
*Dryness, thickening in flexor surfaces including antecubital and popliteal fossae, neck, hands<ref>Leung DYM, Sicherer SH. Atopic Dermatitis (Atopic Eczema). In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020:(Ch) 170.</ref>


==Differential Diagnosis==
==Differential Diagnosis==
{{Neonatal rashes DDX}}
{{Neonatal rashes DDX}}
==Evaluation==
*Clinical diagnosis
**Dry skin, erythematous papular lesions
**Face most commonly involved; nose and diaper areas spared
{{Neonatal atopic dermatitis vs seborrhoeic dermatitis}}
==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) <ref>Fang J. Dermatology. In: The Harriet Lane Handbook. 20th ed. Philadelphia, PA: Elsevier; 2015</ref>
**Alternatives include petroleum jelly and Aquaphor
**If using steroids, apply emollients on top of steroids
*[[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
==Disposition==
*Outpatient


==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]]
==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<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
**Or topical doxepin cream 5% QID


==See Also==
==See Also==
*[[Neonatal Rashes]]
*[[Neonatal Rashes]]
*[[General approach to rashes]]
*[[Pediatric rashes]]
==External Links==
https://pedemmorsels.com/atopic-dermatitis/


==References==
==References==

Latest revision as of 11:34, 14 May 2022

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.

Dermatitis Types

Clinical Features

Atopic dermatitits.jpg
Atopic dermatitis of the inside crease of the elbow.
  • Atopic personal or family history, worse in winter, dry weather
  • Erythema, crusts, fissures, pruritus, excoriations, lichenification

Infantile

  • blisters, crusts, exfoliations
  • Face, scalp, trunk, extensor surfaces, sparing of diaper area
  • 1st few months of life, resolving by age 2
  • Differentiate from impetigo (which may occur alongside)

Childhood

  • ~4-12 years old
  • Wrists, ankles, antecubital and popliteal fossae

Adults

  • >12 years old
  • Dryness, thickening in flexor surfaces including antecubital and popliteal fossae, neck, hands[1]

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) [2]
    • 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[3][4]
    • 25-50mg PO nightly
    • Or topical doxepin cream 5% QID

Disposition

  • Outpatient

Complications

See Also

External Links

https://pedemmorsels.com/atopic-dermatitis/

References

  1. Leung DYM, Sicherer SH. Atopic Dermatitis (Atopic Eczema). In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020:(Ch) 170.
  2. Fang J. Dermatology. In: The Harriet Lane Handbook. 20th ed. Philadelphia, PA: Elsevier; 2015
  3. Hercogova J. Topical anti-itch therapy. Dermatol Ther 18(4):341-3 (2005 Jul-Aug).
  4. 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).