Atopic dermatitis: Difference between revisions
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*Also known as atopic eczema | *Also known as atopic eczema | ||
*A chronic type of inflammatory skin disease affecting many children and adults | *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. | *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. | *Cause is not known, but believed to be due to an interaction between susceptibility genes, the environment, defective skin barrier function, and immunologic responses. | ||
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[[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, pruritus, excoriations, lichenification | *Erythema, crusts, fissures, [[pruritus]], excoriations, lichenification | ||
===Infantile=== | ===Infantile=== | ||
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*Face, scalp, extremities | *Face, scalp, extremities | ||
*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 antecubital and popliteal fossae, neck | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*Reduce drying of skin | *Reduce drying of skin | ||
*Liberal application of emollients (vaseline) | *Liberal application of emollients (vaseline) | ||
*Triamcinolone, hydrocortisone, or betamethasone | *[[Triamcinolone]], [[hydrocortisone]], or [[betamethasone]] | ||
*Avoid fluoridinated steroids to the face | *Avoid fluoridinated steroids to the face | ||
*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> | *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 | **25-50mg PO nightly | ||
**Or topical doxepin cream 5% QID | **Or topical doxepin cream 5% QID | ||
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==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]] | ||
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==See Also== | ==See Also== | ||
*[[Neonatal Rashes]] | *[[Neonatal Rashes]] | ||
*[[General approach to rashes]] | |||
*[[Pediatric rashes]] | |||
==References== | ==References== |
Revision as of 17:50, 28 March 2017
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
- 1st few months of life, resolving by age 2
- Differentiate from impetigo (which may occur alongside)
Adults
- Dryness, thickening in antecubital and popliteal fossae, 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 pruritus[1][2]
- 25-50mg PO nightly
- Or topical doxepin cream 5% QID
Disposition
- Outpatient
Complications
- Secondary bacterial infection
- Eczema herpeticum, widespread HSV infection
- Dyshidrotic eczema