Atopic%20dermatitis Signs and Symptoms
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 with oozing, crusting and 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
- 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 and hands
- Hand dermatitis may be present in the adult due to exposure to irritating chemicals
- Dry, scaling, erythematous papules and plaques