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Atopic Dermatitis

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Information about Atopic Dermatitis

Published on May 25, 2008

Author: ah.alraiyes

Source: slideshare.net

Description

Dermatitis
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Abdul Hamid Alraiyes 05/16/08

 Chronic Relapsing Skin Disease  Most commonly during early infancy and childhood  Prevalence 15% to 20% in Industrialized Nations during early childhood  AD remains a clinical diagnosis  Pruritus is a consistent feature

(1) a personal or family history of atopic disease (asthma, allergic rhinitis, atopic dermatitis), (2) xerosis-ichthyosis, (3) facial pallor with infraorbital darkening, (4) elevated serum IgE, (5) fissures under the ear lobes, (6) a tendency toward nonspecific hand dermatitis, (7) a tendency toward repeated skin infections, and (8) nipple eczema.

 Complex integration of environmental and genetic factors  Wool, lanolin and harsh detergents are particularly irritating  Emotional stress can lead to flares  Exclusive breast feeding for first 3 months of life is associate with lower incidence rates of atopic dermatitis during childhood in children with a family history of atopy

 Varies with the age  Infancy:ill-defined scaling, erythematous patches and confluent, edematous papules and vesicles are typical.  Scalp and face are most often involved  When crawling : extensor surfaces especially knees are involved

 Varies with the age  Childhood : lesions are drier, less eczematous, involve flexural areas & neck  Scaling, fissured & crusted hands become troublesome  Infraorbital folds (Morgan lines) and pityriasis alba may appear

 Varies with the age  Childhood : lesions are drier, less eczematous, involve flexural areas & neck  Scaling, fissured & crusted hands become troublesome  Infraorbital folds (Morgan lines) and pityriasis alba may appear

 Adults: Chronic or chronically relapsing pruritic, erythematous, papulovesicular eruptions that progress to scaling, lichenified dermatitis is common  Extensive skin involvement: face, chest, neck, flanks, hands and flexural distribution noted  10% to 15% of AD persists into puberty  Associated features: asthma , allergic rhinitis, secondary bacterial infections  Cutaneous fungal & viral infections can occur frequently and with increased severity in AD  Ocular complications exist: anterior subcapsular cataracts, retinal detachment, blepharitis, conjunctivitis, keratoconus

 Adults: Chronic or chronically relapsing pruritic, erythematous, papulovesicular eruptions that progress to scaling, lichenified dermatitis is common  Extensive skin involvement: face, chest, neck, flanks, hands and flexural distribution noted  10% to 15% of AD persists into puberty  Associated features: asthma , allergic rhinitis, secondary bacterial infections  Cutaneous fungal & viral infections can occur frequently and with increased severity in AD  Ocular complications exist: anterior subcapsular cataracts, retinal detachment, blepharitis, conjunctivitis, keratoconus

 Adults: Chronic or chronically relapsing pruritic, erythematous, papulovesicular eruptions that progress to scaling, lichenified dermatitis is common  Extensive skin involvement: face, chest, neck, flanks, hands and flexural distribution noted  10% to 15% of AD persists into puberty  Associated features: asthma , allergic rhinitis, secondary bacterial infections  Cutaneous fungal & viral infections can occur frequently and with increased severity in AD  Ocular complications exist: anterior subcapsular cataracts, retinal detachment, blepharitis, conjunctivitis, keratoconus

Major criteria •Personal or family history of atopy •Characteristic morphology and distribution of lesions •Pruritus •Chronic or chronically recurring dermatosis Minor features •Hyperimmunoglobulinemia E •Food intolerance •Intolerance to wool and lipid solvents •Recurrent skin infections •Xerosis •Chronically scaling scalp •Recurrent conjunctivitis •Anterior subcapsular cataracts and keratoconus •Morgan line, or Dennie sign (single or double creases in the lower eyelid •Pityriasis alba (hypopigmented, scaling patches, typically on the cheeks) •Hyperlinear palms (increased folds, typically on the thenar or hypothenar eminence

1. Food allergy is an uncommon cause of flares of atopic dermatitis in adults. Blinded food challenges are the most reliable method of diagnosing suspected food allergy. 2. Radioallergosorbent tests (RASTs) or skin tests may suggest dust mite allergy. 3. Eosinophilia and increased serum IgE levels may be present but are nonspecific.

Type Disorders Allergic contact dermatitis Dermatitis herpetiformis Irritant contact dermatitis (may be Dermatitides concomitant with atopic dermatitis) Nummular eczema Seborrheic dermatitis Ichthyoses Ichthyosis vulgaris Graft versus host disease HIV-associated dermatosis Hyperimmunoglobulinemia E Immunologic disorders syndrome Wiskott-Aldrich syndrome Infectious diseases Scabies Dermatophytosis Metabolic disorders Zinc deficiency Various inborn errors of metabolism Neoplastic disorders Cutaneous T cell lymphoma Rheumatologic disorders Dermatomyositis

 Reduction of trigger factors  Bland emollients, mild non alkali soaps  Bubble baths, scented salts and oil can be irritating  100% Cotton clothing is preferable to wool and synthetics  Topical steroids are the main stay of treatment  Systemic steroids for severe, acute flares  Calcineurin inhibitors: tacrolimus, pimecrolimus: no skin atrophy, therefore, useful on face and neck  Antihistamines helpful in breaking itch-scratch cycle

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