atopic%20dermatitis
ATOPIC DERMATITIS
Atopic dermatitis or atopic eczema is a 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 with 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 diseases afflicting both children and adults.

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”
  • One of the most common skin diseases afflicting both children and 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 and protein formation
  • Susceptibility to infections caused by Staphylococcus aureus/epidermidis and Malassezia furfur
  • Common causes include allergens such as food, soaps, detergents, inhalant allergens and 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 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 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 and plaques
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