Atopic dermatitis: Difference between revisions
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*Triamcinolone, hydrocortisone, or betamethasone | *Triamcinolone, hydrocortisone, or betamethasone | ||
*Avoid fluoridinated steroids to the face | *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== | ||
Revision as of 16:46, 8 June 2016
Background
- Must distinguish from Seborrheic Dermatitis
- Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
- Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
Clinical features
- Atopic personal or family hx, worse in winter, dry weather
- Erythema, crusts, fissures, pruritis, excoriations, lichenification
- Infantile form - 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
Diagnosis
- Dry skin, erythematous papular lesions
- Face most commonly involved; nose and diaper areas spared
Differential Diagnosis
Neonatal Rashes
- Acne
- Atopic dermatitis
- Candidiasis
- Contact dermatitis
- Diaper dermatitis
- Erythema toxicum neonatorum
- Impetigo
- Mastitis
- Milia
- Miliaria
- Mongolian spots
- Omphalitis
- Perianal streptococcal dermatitis
- Psoriasis
- Pustular melanosis
- Seborrheic dermatitis
- Sucking blisters
- Tinea capitis
Complications
- Secondary bacterial infection
- Eczema herpeticum, widespread HSV infection
- 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[1][2]
- 25-50 mg PO qhs
- Or topical doxepin cream 5% QID
See Also
Sources
- Kim BS et al. Atopic Dermatitis. eMedicine. Jul 1, 2015. http://emedicine.medscape.com/article/1049085-overview.