atopic%20dermatitis%20(pediatric)
ATOPIC DERMATITIS (PEDIATRIC)
Atopic dermatitis is a familial, chronic relapsing inflammatory skin disease characterized by intense itching, dry skin, with inflammation and exudation that commonly presents during early infancy and childhood, but can persist or start in adulthood.
It is also referred to as atopic eczema.
It is one of the most common skin diseases afflicting both adults and children.

Introduction

  • One of the most common skin diseases afflicting both adults & children
  • Infant’s skin has a developing epidermal barrier & would only fully mature at least at 1st year of age thus their skin absorb more water & lose excess water faster than adult skin
    • This skin characteristic makes them susceptible to irritation & infections

Definition

  • A familial, chronic relapsing inflammatory skin disease characterized by intense itching, dry skin, w/ inflammation & exudation that commonly presents during early infancy & childhood, but can persist or start in adulthood
  • Also referred to as “atopic eczema”

Etiology

  • Common causes include allergens such as food, soaps, detergents, inhalant allergens & skin infections

Pathophysiology

  • 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/epidermidisMalassezia furfur

Signs and Symptoms

Infants <2 years usually present w/:

  • Signs of inflammation usually develop during the 3rd month of life
  • Patient commonly presents w/ 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 w/ 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 w/ generalized eruptions
    •  Papules, redness, scaling & lichenification
    •  Diaper area is usually not affected

Children 2-12 years usually present w/:

  • 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

Adolescents ≥12 years usually present w/:

  • Resurgence of inflammation that recurs near puberty
  • Pattern of inflammation is the same as in a child 2-12 years
  • Dry, scaling, erythematous papules & plaques
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