atopic dermatitis
Post on 16-Nov-2014
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Abdul Hamid Alraiyes
05/16/08
Chronic Relapsing Skin Disease
Most commonly during early infancy and
childhood
Prevalence 15% to 20% in Industrialized
Nations during early childhood
AD remains a clinical diagnosis
Pruritus is a consistent feature
(1) a personal or family history of atopic disease
(asthma, allergic rhinitis, atopic dermatitis),
(2) xerosis-ichthyosis,
(3) facial pallor with infraorbital darkening,
(4) elevated serum IgE,
(5) fissures under the ear lobes,
(6) a tendency toward nonspecific hand
dermatitis,
(7) a tendency toward repeated skin infections,
and
(8) nipple eczema.
Complex integration of environmental and
genetic factors
Wool, lanolin and harsh detergents are
particularly irritating
Emotional stress can lead to flares
Exclusive breast feeding for first 3 months of
life is associate with lower incidence rates of
atopic dermatitis during childhood in
children with a family history of atopy
Varies with the age
Infancy:ill-defined scaling,
erythematous patches and
confluent, edematous papules
and vesicles are typical.
Scalp and face are most often
involved
When crawling : extensor
surfaces especially knees are
involved
Varies with the age
Childhood : lesions are drier,
less eczematous, involve
flexural areas & neck
Scaling, fissured & crusted
hands become troublesome
Infraorbital folds (Morgan lines)
and pityriasis alba may appear
Varies with the age
Childhood : lesions are drier,
less eczematous, involve
flexural areas & neck
Scaling, fissured & crusted
hands become troublesome
Infraorbital folds (Morgan lines)
and pityriasis alba may appear
Adults: Chronic or chronically relapsing pruritic, erythematous, papulovesicular eruptions that progress to scaling, lichenifieddermatitis is common
Extensive skin involvement: face, chest, neck, flanks, hands and flexural distribution noted
10% to 15% of AD persists into puberty
Associated features: asthma , allergic rhinitis, secondary bacterial infections
Cutaneous fungal & viral infections can occur frequently and with increased severity in AD
Ocular complications exist: anterior subcapsular cataracts, retinal detachment, blepharitis, conjunctivitis, keratoconus
Adults: Chronic or chronically relapsing pruritic, erythematous, papulovesicular eruptions that progress to scaling, lichenifieddermatitis is common
Extensive skin involvement: face, chest, neck, flanks, hands and flexural distribution noted
10% to 15% of AD persists into puberty
Associated features: asthma , allergic rhinitis, secondary bacterial infections
Cutaneous fungal & viral infections can occur frequently and with increased severity in AD
Ocular complications exist: anterior subcapsular cataracts, retinal detachment, blepharitis, conjunctivitis, keratoconus
Adults: Chronic or chronically relapsing pruritic, erythematous, papulovesicular eruptions that progress to scaling, lichenifieddermatitis is common
Extensive skin involvement: face, chest, neck, flanks, hands and flexural distribution noted
10% to 15% of AD persists into puberty
Associated features: asthma , allergic rhinitis, secondary bacterial infections
Cutaneous fungal & viral infections can occur frequently and with increased severity in AD
Ocular complications exist: anterior subcapsular cataracts, retinal detachment, blepharitis, conjunctivitis, keratoconus
Major criteria•Personal or family history of atopy
•Characteristic morphology and distribution of lesions
•Pruritus
•Chronic or chronically recurring dermatosis
Minor features •Hyperimmunoglobulinemia E
•Food intolerance
•Intolerance to wool and lipid solvents
•Recurrent skin infections
•Xerosis
•Chronically scaling scalp
•Recurrent conjunctivitis
•Anterior subcapsular cataracts and keratoconus
•Morgan line, or Dennie sign (single or double creases in
the lower eyelid
•Pityriasis alba (hypopigmented, scaling patches, typically
on the cheeks)
•Hyperlinear palms (increased folds, typically on the
thenar or hypothenar eminence
1. Food allergy is an uncommon cause of
flares of atopic dermatitis in adults. Blinded
food challenges are the most reliable
method of diagnosing suspected food
allergy.
2. Radioallergosorbent tests (RASTs) or skin
tests may suggest dust mite allergy.
3. Eosinophilia and increased serum IgE levels
may be present but are nonspecific.
Type Disorders
Allergic contact dermatitis
Dermatitis herpetiformis
Dermatitides Irritant contact dermatitis (may be
concomitant with atopic dermatitis)
Nummular eczema
Seborrheic dermatitis
Ichthyoses Ichthyosis vulgaris
Graft versus host disease
HIV-associated dermatosis
Immunologic disorders Hyperimmunoglobulinemia E
syndrome
Wiskott-Aldrich syndrome
Infectious diseases Scabies
Dermatophytosis
Metabolic disorders Zinc deficiency
Various inborn errors of metabolism
Neoplastic disorders Cutaneous T cell lymphoma
Rheumatologic disorders Dermatomyositis
Reduction of trigger factors
Bland emollients, mild non alkali soaps
Bubble baths, scented salts and oil can be irritating
100% Cotton clothing is preferable to wool and synthetics
Topical steroids are the main stay of treatment
Systemic steroids for severe, acute flares
Calcineurin inhibitors: tacrolimus, pimecrolimus: no skin atrophy, therefore, useful on face and neck
Antihistamines helpful in breaking itch-scratch cycle
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