• 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

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

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

• 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