Atopic Dermatitis

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Abdul Hamid Alraiyes 05/16/08

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Dermatitis

Transcript of Atopic Dermatitis

  • 1. Abdul Hamid Alraiyes 05/16/08

2. ChronicRelapsing 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 3. (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. 4. Complexintegration 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 5. 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 6. 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 7. 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 8. 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 9. 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 10. 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 11. 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 12. 1. Food allergy is an uncommon cause offlares of atopic dermatitis in adults. Blindedfood challenges are the most reliablemethod of diagnosing suspected foodallergy. 2. Radioallergosorbent tests (RASTs) or skintests may suggest dust mite allergy. 3. Eosinophilia and increased serum IgE levelsmay be present but are nonspecific. 13. TypeDisorders Allergic contact dermatitisDermatitis herpetiformisIrritant contact dermatitis (may beDermatitides concomitant with atopic dermatitis) Nummular eczema Seborrheic dermatitisIchthyoses Ichthyosis vulgarisGraft versus host disease HIV-associated dermatosis Hyperimmunoglobulinemia E Immunologic disorderssyndrome Wiskott-Aldrich syndromeInfectious diseasesScabiesDermatophytosis Metabolic disorders Zinc deficiency Various inborn errors of metabolism Neoplastic disordersCutaneous T cell lymphoma Rheumatologic disordersDermatomyositis 14. 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