Dermatology Search
Dermatology Dermatology
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 in some individuals
  • 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 skin
    • Lesions (red papules w/ oozing, crusting & scaling) 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
  • 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
  • Scratching and chronic inflammation 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 similar as in a child 2-12 years with additional lesions on nape & hands
  • Hand dermatitis may be present in the adult due to exposure to irritating chemicals
  • Dry, scaling, erythematous papules and plaques
Editor's Recommendations
Most Read Articles
Avoiding chemicals in skincare products an important part of eczema management
Dr Joslyn Ngu, 12 Sep 2017

Even though there is no cure for eczema, the skin disorder can be safely and effectively controlled by avoiding and eliminating allergens, says a clinician.
Elderly individuals predisposed to tinea unguium
Stephen Padilla, 26 Nov 2018
A 10-year retrospective study at Singapore General Hospital (SGH) has shown that majority of patients with tinea unguium, a common nail infection, are aged ≥60 years. In this cohort, patients of Indian and other ethnicities are over-represented for tinea unguium compared to Chinese and Malay patients.