Difference between revisions of "Atopic dermatitis"
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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. | ||
| + | ==Clinical Features== | ||
[[File:Atopic dermatitits.jpg|200px|thumb]] | [[File:Atopic dermatitits.jpg|200px|thumb]] | ||
| − | + | *Atopic personal or family history, worse in winter, dry weather | |
| − | + | *Erythema, crusts, fissures, [[pruritus]], excoriations, lichenification | |
| − | *Atopic personal or family | ||
| − | *Erythema, crusts, fissures, | ||
===Infantile=== | ===Infantile=== | ||
*blisters, crusts, exfoliations | *blisters, crusts, exfoliations | ||
| − | *Face, scalp, extremities | + | *Face, scalp, extremities, 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) |
===Adults=== | ===Adults=== | ||
| − | *Dryness, thickening in | + | *Dryness, thickening in flexor surfaces including antecubital and popliteal fossae, neck |
==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}} | ||
==Management== | ==Management== | ||
| − | *Identify and eliminate triggers | + | *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 | ||
| Line 41: | Line 54: | ||
==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]] | ||
| Line 47: | Line 60: | ||
==See Also== | ==See Also== | ||
*[[Neonatal Rashes]] | *[[Neonatal Rashes]] | ||
| + | *[[General approach to rashes]] | ||
| + | *[[Pediatric rashes]] | ||
==References== | ==References== | ||
Latest revision as of 01:38, 24 March 2020
Contents
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.
Clinical Features
- Atopic personal or family history, worse in winter, dry weather
- Erythema, crusts, fissures, pruritus, excoriations, lichenification
Infantile
- blisters, crusts, exfoliations
- Face, scalp, extremities, sparing of diaper area
- 1st few months of life, resolving by age 2
- Differentiate from impetigo (which may occur alongside)
Adults
- Dryness, thickening in flexor surfaces including antecubital and popliteal fossae, neck
Differential Diagnosis
Neonatal Rashes
- Atopic dermatitis
- 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) [1]
- 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[2][3]
- 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
References
- ↑ 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).