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.

Atopic%20dermatitis%20(pediatric) Signs and Symptoms

Introduction

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

Definition

  • 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
  • Also referred to as “atopic eczema”

Etiology

  • Common causes include allergens such as food, soaps, detergents, inhalant allergens and 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 and protein formation
  • Susceptibility to infections caused by Staphylococcus aureus/epidermidis and Malassezia furfur

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 and/or chin
    • Lip licking may result in scaling, oozing and crusting on the lips and perioral skin, eventually leading to secondary infections
    • Perioral and perinasal sparing can be characteristic and 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 and 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 and popliteal fossae, wrists and ankles
  •  Papules that quickly change to plaques then lichenified when scratched
  •  Constant scratching may lead to excoriations and eventual areas of hypo- or hyperpigmentation

Adolescents ≥12 years usually present with:

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