Atopic dermatitis: Difference between revisions
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*Cause is not known, but believed to be due to an interaction between susceptibility genes, the environment, defective skin barrier function, and immunologic responses. | *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 | *Atopic personal or family history, worse in winter, dry weather | ||
*Erythema, crusts, fissures, pruritis, excoriations, lichenification | *Erythema, crusts, fissures, pruritis, excoriations, lichenification | ||
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**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 | ||
===Distinguish from [[Seborrheic Dermatitis]]=== | |||
*Occurs between 2-6mo (somewhat later than seborrheic dermatitis) | |||
*Pruritic (may manifest as fussiness) vs seborrheic (not pruritic) | |||
==Management== | ==Management== | ||
Revision as of 01:35, 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
- 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
Evaluation
- Clinical diagnosis
- Dry skin, erythematous papular lesions
- Face most commonly involved; nose and diaper areas spared
Distinguish from Seborrheic Dermatitis
- Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
- Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
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