Atopic dermatitis: Difference between revisions
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==Background== | ==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== | ==Clinical Features== | ||
*Atopic personal or family | [[File:Atopic dermatitits.jpg|thumb|]] | ||
*Erythema, crusts, fissures, | [[File:Atopy2010.jpg|thumb|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=== | ===Infantile=== | ||
*blisters, crusts, exfoliations | *blisters, crusts, exfoliations | ||
*Face, scalp, | *Face, scalp, trunk, extensor surfaces, sparing of diaper area | ||
*1st few months of life, resolving by age 2 | *1st few months of life, resolving by age 2 | ||
*Differentiate from impetigo (which may occur alongside) | *Differentiate from [[impetigo]] (which may occur alongside) | ||
===Childhood=== | |||
*~4-12 years old | |||
*Wrists, ankles, antecubital and popliteal fossae | |||
===Adults=== | ===Adults=== | ||
*Dryness, thickening in | *>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 | *Clinical diagnosis | ||
**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 | ||
== | {{Neonatal atopic dermatitis vs seborrhoeic dermatitis}} | ||
*Identify and eliminate triggers | |||
==Management== | |||
*Identify and eliminate triggers: | |||
**Alcohol based products | |||
**Fragrances and astringents | |||
**Excessive bathing | |||
**Allergens | |||
*Reduce drying of skin | *Reduce drying of skin | ||
*Liberal application of emollients (vaseline) | **Avoid lotions (high water and low oil content) | ||
*Triamcinolone, hydrocortisone, or betamethasone | *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> | ||
*Avoid fluoridinated steroids to | **Alternatives include petroleum jelly and Aquaphor | ||
*Consider [[doxepin]] for recalcitrant | **If using steroids, apply emollients on top of steroids | ||
**25- | *[[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 | **Or topical doxepin cream 5% QID | ||
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==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]] | ||
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==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
- Atopic dermatitis
- Candida dermatitis
- Cercarial dermatitis
- Contact dermatitis
- Dermatitis herpetiformis
- Diaper dermatitis
- Dyshidrotic dermatitis
- Neonatal seborrhoeic dermatitis
- Nummular dermatitis
- Perianal streptococcal dermatitis
- Perioral dermatitis
- Seborrheic dermatitis
- Stasis dermatitis
Clinical Features
- 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
- Atopic dermatitis
- Candidiasis
- Diaper dermatitis
- Erythema toxicum neonatorum
- Neonatal acne
- Psoriasis
- Seborrheic dermatitis
- Tinea capitis
- Impetigo
- Contact dermatitis
- Perianal streptococcal dermatitis
- Milia
- Miliaria
- Mongolian spots
- Omphalitis
- Pustular melanosis
- Sucking blisters
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
- 7 days of low or medium potency steroid ointments either daily or BID
- 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[3][4]
- 25-50mg PO nightly
- Or topical doxepin cream 5% QID
Disposition
- Outpatient
Complications
- Secondary bacterial infection
- Eczema herpeticum, widespread HSV infection
- Dyshidrotic eczema
See Also
External Links
https://pedemmorsels.com/atopic-dermatitis/
References
- ↑ 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.
- ↑ Fang J. Dermatology. In: The Harriet Lane Handbook. 20th ed. Philadelphia, PA: Elsevier; 2015
- ↑ Hercogova J. Topical anti-itch therapy. Dermatol Ther 18(4):341-3 (2005 Jul-Aug).
- ↑ 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).