ATOPIC DERMATITIS

Atopy?
Prevalence is 10% in children and 1% in the adult
population
Rising
AD may be more common among Caucasian and
Chinese persons, but it affects all races.
Sex: The male-to-female ratio is 1:1.4.
Age: In 85% of cases, AD occurs in the first year of
life, and in 95% of cases, it occurs before age 5
years.

criteria

Major
1.pruritus
2.typical morhology and distribution
3.chronicity
4.family history of atopy

Minor criteria

Xerosis
Icthyosis/hyperlinear
palms/keratosis p.
IgE reactivity
Elevated IgE level
Early onset
Skin infection
Chelitis
Nipple eczema

Recurrent conjuctivitis
Keratoconus
Dennie morgan fold
Anterior c. cataract
Orbital darkening
Facial erythema
Pityriasis alba
Food hypersensitivity
White dermatographism

SKIN INFECTIONS
STAPH AURIOUS:
1.folliculitis
2.impetigo
HSV
SMALL POX
TRICHOPHYTON RUBRUM
MALASSEZIA FURFUR

PHYSICAL

Infancy
xerosis, often spares the diaper area.
folds (antecubital and popliteal fossae). The
appearance is erythematous with exudative
patches. Over a few weeks, lesions localize to the
cheeks and forehead and extensors of the lower
legs but may occur on any location on the body.
The scalp is dry and flaky.
Lichenification is not seen often in infancy.

PHYSICAL

Childhood
Xerosis often is generalized.
Lesions are eczematous and exudative. Often,
pallor of the face is noted, with erythema and
crusting around the eyes.
Flexural creases most often are affected, including
the antecubital and popliteal fossae and buttockthigh crease.
Excoriations and crusting are common
LESS WEEPY

PHYSICAL

Adulthood
Lesions become more diffuse with an
underlying background of erythema. The face
commonly is involved.
Dryness is prominent.
Lichenification is present.
A brown ring around the neck is typical but
not always present

Causes

chromosome 11q13 or 5q31.

colonization by S aureus.
AD flares in extremes of climate. Heat is poorly
tolerated, as is extreme cold. A dry atmosphere
increases dry skin. Sun exposure improves lesions,
but sweating increases pruritus.
The role of food ??
role for aeroallergens and house dust mites??.
autoallergens

Pathophysiology

IL4 /IL5/ IL10 are all increased

Laboratory findings suggest an abnormality of T
helper 2 (TH2) cells resulting in increased
production of interleukin 4 (IL-4) and increased IgE.
The excess IL-4 causes decreased interferon
levels. Cells may react with environmental antigens
to produce increased levels of IgE.
Serum histamine is increased
stratum corneum abnormalities of lipid (particularly
ceramide production).
abnormality of prostaglandin metabolism

Differential diagnosis
Contact dermatitis
Ataxia-telangiectasia syndrome
Histiocytosis X
Lichen simplex chronicus
Photosensitivity rashes
Psoriasis
Wiskott-Aldrich syndrome
Seborrheic dermatitis
Mycosis fungoides
scabies
Ichthyosis vulgaris

workup

Laboratory testing is seldom necessary.

Allergy testing is of little value.
Radioallergosorbent assay is of little value.
Food challenge/elimination diet
Perform CBC for thrombocytopenia to exclude WiskottAldrich syndrome.
T-cell markers to exclude immunodeficiency
Scraping to exclude tinea corporis
Histologic Findings: Biopsy shows an acute, subacute, or
chronic dermatitis, but no specific findings are demonstrated.

treatment

Moisturization
Topical steroids
UV light: UV-A, UV-B, NBUVB
Antihistamines:
Ketotifen
Oil of evening primrose
Antibiotics (cloxacillin or cephalexin)
Ascomycin
Tacrolimus (topical FK506)
methotrexate and cyclosporine