atopic%20dermatitis
ATOPIC DERMATITIS
Atopic dermatitis or atopic eczema is chronic, relapsing, familial, symmetric and pruritic inflammatory skin disease that commonly presents during early infancy and childhood, but can persist or start in adulthood.
It is commonly associated w/ elevated serum immunoglobulin E levels and a personal or family history of allergies, allergic rhinitis and asthma.
It is one of the most common skin disease afflicting both children and adults.

Definition

  • A familial, chronic relapsing inflammatory skin disease characterized by intense itching, dry skin, with inflammation & exudation that commonly presents during early infancy & childhood, but can persist or start in adulthood
  • Also referred to as “atopic eczema”
  • One of the most common skin diseases afflicting both children & adults

Pathophysiology

Pathophysiologic features:

  • Heredity (80% in monozygous twins, 20% in heterozygous twins)
  • Increased immunoglobulin E (IgE) production
  • Lack of skin barrier producing dry skin due to abnormalities in lipid metabolism & protein formation
  • Susceptibility to infections caused by Staphylococcus aureus/epidermidis & Malassezia furfur
  • Common causes include allergens such as food, soaps, detergents, inhalant allergens & skin infections
  • Presence of filaggrin (FLG) gene defects increase the risk of developing atopic dermatitis

Signs and Symptoms


Infants <2 years usually present with:

  • Signs of inflammation usually develop during the 3rd month of life
  • Patient commonly presents with red, scaling, dry areas
    • Usually found on the facial cheeks &/or chin
    • Lip licking may result in scaling, oozing & crusting on the lips & perioral skin, eventually leading to secondary infections
    • Perioral & perinasal sparing can be characteristic & patient may present with no lesions in these areas
  • Continued scratching or washing will create scaling, oozing, red plaques on cheeks
    • Infant may be restless or agitated during sleep
  • A small number of infants may present with generalized eruptions
    • Papules, redness, scaling & lichenification
    • Diaper area is usually not affected
Children 2-12 years usually present with:
  • Inflammation in the flexural areas
    • Eg neck, wrists, ankles, antecubital fossae
  • Rash may be contained to 1 or 2 areas
    • May progress to involve more areas eg neck, antecubital & popliteal fossae, wrists & ankles
  • Papules that quickly change to plaques then lichenified when scratched
  • Constant scratching may lead to areas of hypo- or hyperpigmentation

12 years-Adults Usually Present with:

  • Resurgence of inflammation that recurs near puberty onset
  • It is unusual for adults with no history of dermatitis in earlier years, to present with new onset dermatitis
  • Pattern of inflammation is the same as in a child 2-12 years
  • Hand dermatitis may be present in the adult due to exposure to irritating chemicals
  • Dry, scaling, erythematous papules & plaques
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