- 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.
- Atopic personal or family history, worse in winter, dry weather
- Erythema, crusts, fissures, pruritus, excoriations, lichenification
- blisters, crusts, exfoliations
- Face, scalp, trunk, extensor surfaces, sparing of diaper area
- 1st few months of life, resolving by age 2
- Differentiate from impetigo (which may occur alongside)
- ~4-12 years old
- Wrists, ankles, antecubital and popliteal fossae
- >12 years old
- Dryness, thickening in flexor surfaces including antecubital and popliteal fossae, neck, hands
- Clinical diagnosis
- Dry skin, erythematous papular lesions
- Face most commonly involved; nose and diaper areas spared
- Identify and eliminate triggers:
- Alcohol based products
- Fragrances and astringents
- Excessive bathing
- 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) 
- Alternatives include petroleum jelly and Aquaphor
- If using steroids, apply emollients on top of steroids
- Topical steroids
- 7 days of low or medium potency steroid ointments either daily or BID
- Severe flares require high potency steroids followed by a taper
- Avoid fluoridinated steroids to thin skin areas such as face, groin, or axilla
- Consider doxepin for recalcitrant pruritus
- 25-50mg PO nightly
- Or topical doxepin cream 5% QID
- ↑ Leung DYM, Sicherer SH. Atopic Dermatitis (Atopic Eczema). In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020:(Ch) 170.
- ↑ Fang J. Dermatology. In: The Harriet Lane Handbook. 20th ed. Philadelphia, PA: Elsevier; 2015
- ↑ Hercogova J. Topical anti-itch therapy. Dermatol Ther 18(4):341-3 (2005 Jul-Aug).
- ↑ 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).