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, lichenifieddermatitis 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, lichenifieddermatitis 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, lichenifieddermatitis 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

Dermatitides Irritant contact dermatitis (may be

concomitant with atopic dermatitis)

Nummular eczema

Seborrheic dermatitis

Ichthyoses Ichthyosis vulgaris

Graft versus host disease

HIV-associated dermatosis

Immunologic disorders Hyperimmunoglobulinemia E

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