Abdul Hamid Alraiyes

05/16/08
 Chronic Relapsing Skin Disease
 Most commonly during early infancy and
childhood
 Prevalence 15% to 20% in Industrialized
Nations during early childhood
 AD remains a clinical diagnosis
 Pruritus is a consistent feature
(1) a personal or family history of atopic disease
(asthma, allergic rhinitis, atopic dermatitis),
(2) xerosis-ichthyosis,
(3) facial pallor with infraorbital darkening,
(4) elevated serum IgE,
(5) fissures under the ear lobes,
(6) a tendency toward nonspecific hand
dermatitis,
(7) a tendency toward repeated skin infections,
and
(8) nipple eczema.
 Complex integration of environmental and
genetic factors
 Wool, lanolin and harsh detergents are
particularly irritating
 Emotional stress can lead to flares
 Exclusive breast feeding for first 3 months of
life is associate with lower incidence rates of
atopic dermatitis during childhood in
children with a family history of atopy
 Varies with the age
 Infancy:ill-defined scaling,
erythematous patches and
confluent, edematous papules
and vesicles are typical.
 Scalp and face are most often
involved
 When crawling : extensor
surfaces especially knees are
involved
 Varies with the age
 Childhood : lesions are drier,
less eczematous, involve
flexural areas & neck
 Scaling, fissured & crusted
hands become troublesome
 Infraorbital folds (Morgan lines)
and pityriasis alba may appear
 Varies with the age
 Childhood : lesions are drier,
less eczematous, involve
flexural areas & neck
 Scaling, fissured & crusted
hands become troublesome
 Infraorbital folds (Morgan lines)
and pityriasis alba may appear
 Adults: Chronic or chronically
relapsing pruritic, erythematous,
papulovesicular eruptions that
progress to scaling, lichenified
dermatitis is common
 Extensive skin involvement: face,
chest, neck, flanks, hands and
flexural distribution noted
 10% to 15% of AD persists into
puberty
 Associated features: asthma ,
allergic rhinitis, secondary bacterial
infections
 Cutaneous fungal & viral infections
can occur frequently and with
increased severity in AD
 Ocular complications exist: anterior
subcapsular cataracts, retinal
detachment, blepharitis,
conjunctivitis, keratoconus
 Adults: Chronic or chronically
relapsing pruritic, erythematous,
papulovesicular eruptions that
progress to scaling, lichenified
dermatitis is common
 Extensive skin involvement: face,
chest, neck, flanks, hands and
flexural distribution noted
 10% to 15% of AD persists into
puberty
 Associated features: asthma ,
allergic rhinitis, secondary bacterial
infections
 Cutaneous fungal & viral infections
can occur frequently and with
increased severity in AD
 Ocular complications exist: anterior
subcapsular cataracts, retinal
detachment, blepharitis,
conjunctivitis, keratoconus
 Adults: Chronic or chronically
relapsing pruritic, erythematous,
papulovesicular eruptions that
progress to scaling, lichenified
dermatitis is common
 Extensive skin involvement: face,
chest, neck, flanks, hands and
flexural distribution noted
 10% to 15% of AD persists into
puberty
 Associated features: asthma ,
allergic rhinitis, secondary bacterial
infections
 Cutaneous fungal & viral infections
can occur frequently and with
increased severity in AD
 Ocular complications exist: anterior
subcapsular cataracts, retinal
detachment, blepharitis,
conjunctivitis, keratoconus
Major criteria
•Personal or family history of atopy
•Characteristic morphology and distribution of lesions
•Pruritus
•Chronic or chronically recurring dermatosis
Minor features
•Hyperimmunoglobulinemia E
•Food intolerance
•Intolerance to wool and lipid solvents
•Recurrent skin infections
•Xerosis
•Chronically scaling scalp
•Recurrent conjunctivitis
•Anterior subcapsular cataracts and keratoconus
•Morgan line, or Dennie sign (single or double creases in
the lower eyelid
•Pityriasis alba (hypopigmented, scaling patches, typically
on the cheeks)
•Hyperlinear palms (increased folds, typically on the
thenar or hypothenar eminence
1. Food allergy is an uncommon cause of
flares of atopic dermatitis in adults. Blinded
food challenges are the most reliable
method of diagnosing suspected food
allergy.
2. Radioallergosorbent tests (RASTs) or skin
tests may suggest dust mite allergy.
3. Eosinophilia and increased serum IgE levels
may be present but are nonspecific.
 Type Disorders
Allergic contact dermatitis
Dermatitis herpetiformis
Irritant contact dermatitis (may be
Dermatitides
concomitant with atopic dermatitis)
Nummular eczema
Seborrheic dermatitis
Ichthyoses Ichthyosis vulgaris
Graft versus host disease
HIV-associated dermatosis
Hyperimmunoglobulinemia E
Immunologic disorders
syndrome
Wiskott-Aldrich syndrome
Infectious diseases Scabies
Dermatophytosis
Metabolic disorders Zinc deficiency
Various inborn errors of metabolism
Neoplastic disorders Cutaneous T cell lymphoma
Rheumatologic disorders Dermatomyositis
 Reduction of trigger factors
 Bland emollients, mild non alkali soaps
 Bubble baths, scented salts and oil can be
irritating
 100% Cotton clothing is preferable to wool and
synthetics
 Topical steroids are the main stay of treatment
 Systemic steroids for severe, acute flares
 Calcineurin inhibitors: tacrolimus, pimecrolimus:
no skin atrophy, therefore, useful on face and
neck
 Antihistamines helpful in breaking itch-scratch
cycle