Atopic dermatitis: Difference between revisions
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*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.
{{Dermatitis types}}


==Clinical Features==
==Clinical Features==
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===Infantile===
===Infantile===
*blisters, crusts, exfoliations
*blisters, crusts, exfoliations
*Face, scalp, extremities
*Face, scalp, extremities, sparing of diaper area
*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 antecubital and popliteal fossae, neck
*Dryness, thickening in flexor surfaces including antecubital and popliteal fossae, neck


==Differential Diagnosis==
==Differential Diagnosis==
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==Management==
==Management==
*Identify and eliminate triggers
*Identify and eliminate triggers:
**Alcohol based products
**Fragrances and astringents
**Excessive bathing
**Allergens
*Reduce drying of skin
*Reduce drying of skin
*Liberal application of emollients (vaseline)
**Avoid lotions (high water and low oil content)
*[[Triamcinolone]], [[hydrocortisone]], or [[betamethasone]]
*Liberal application of emollients (vaseline) immediately after bath (<5 min, skin should be pat dry instead of rubbing) <ref>Fang J. Dermatology. In: The Harriet Lane Handbook. 20th ed. Philadelphia, PA: Elsevier; 2015</ref>
*[[Topical steroid potency]] for additional options
**Alternatives include petroleum jelly and Aquaphor
*Avoid fluoridinated steroids to the face
**If using steroids, apply emollients on top of steroids
*[[Topical steroids]]
**7 days of low or medium potency steroid ointments either daily or BID
***[[Triamcinolone]], [[hydrocortisone]], or [[betamethasone]]
**Severe flares require high potency steroids followed by a taper
***[[Topical steroid potency]] for additional options
*Avoid fluoridinated steroids to thin skin areas such as face, groin, or axilla
*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 nightly
**25-50mg PO nightly

Revision as of 22:42, 10 September 2020

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.

Dermatitis Types

Clinical Features

Atopic dermatitits.jpg
  • Atopic personal or family history, worse in winter, dry weather
  • Erythema, crusts, fissures, pruritus, excoriations, lichenification

Infantile

  • blisters, crusts, exfoliations
  • Face, scalp, extremities, sparing of diaper area
  • 1st few months of life, resolving by age 2
  • Differentiate from impetigo (which may occur alongside)

Adults

  • Dryness, thickening in flexor surfaces including antecubital and popliteal fossae, neck

Differential Diagnosis

Neonatal Rashes

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:
    • Alcohol based products
    • Fragrances and astringents
    • Excessive bathing
    • Allergens
  • Reduce drying of skin
    • Avoid lotions (high water and low oil content)
  • Liberal application of emollients (vaseline) immediately after bath (<5 min, skin should be pat dry instead of rubbing) [1]
    • Alternatives include petroleum jelly and Aquaphor
    • If using steroids, apply emollients on top of steroids
  • Topical steroids
  • Avoid fluoridinated steroids to thin skin areas such as face, groin, or axilla
  • Consider doxepin for recalcitrant pruritus[2][3]
    • 25-50mg PO nightly
    • Or topical doxepin cream 5% QID

Disposition

  • Outpatient

Complications

See Also

References

  1. ↑ Fang J. Dermatology. In: The Harriet Lane Handbook. 20th ed. Philadelphia, PA: Elsevier; 2015
  2. ↑ Hercogova J. Topical anti-itch therapy. Dermatol Ther 18(4):341-3 (2005 Jul-Aug).
  3. ↑ 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).
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