Atopic dermatitis: Difference between revisions
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**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== | ||
Revision as of 01:41, 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 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
- 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
- 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
- Secondary bacterial infection
- Eczema herpeticum, widespread HSV infection
- Dyshidrotic eczema