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The word ‘eczema’ comes from the Greek for ‘boiling’ – a reference to
the tiny vesicles (bubbles) that are often seen in the early acute stages
of the disorder, but less often in its later chronic stages.
The
inheritance
Exacerbating Eliciting
Factors Factors
The inheritance
SKIN
BARRIER
ENVIRONM
IMMUNOL GENITIC ENAL
OGIC
PHARMAC
OLOGIC
Genetics
The inheritance were recognized early, Higher
risk was associated with maternal rather than
paternal atopy.
There is a similar
distribution, mostly
flexural but also face
and neck, with
lichenification and
exoriations being the
most conspicuous
symptoms. May be
generalized.
Associated Clinical Features
Pruritus
• the hallmark of AD.
• worse in the evening, by
sweating or wool clothing.
• The rubbing and scratching
exacerbate pathogenic
events >> the dermatitis.
Excoriations
• Scratching & rubbing can
produce lichenified plaques
and prurigo nodularis.
Xerosis
cardinal feature of AD (dry,
scaly skin in a generalized
distribution ( beyond areas
of active dermatitis).
Xerosis seen in 80–98% of
AD patients.
Impaired epidermal barrier
function decreased water
content in the stratum
corneum >>> easier entry
of irritants, promotes
pruritus and initiate an
inflammatory response.
Keratosis pilaris
• Excessive keratinization
leading to horny plugs
within hair follicle orifices.
• seen primarily on the lateral
aspects of the upper arms
and thighs and the cheeks
in children.
• A small rim of erythema
surrounds the involved hair
follicles.
Ichthyosis vulgaris
• Up to 50% of AD
patients have this
autosomal dominant
disorder
• characterized by
excessive scaling, which
spares the flexures
Dennie–Morgan lines
• symmetric, prominent fold
(single or double) beneath the
margin of the lower eyelid.
• originates in or near the inner
canthus and extends to one-half
to two-thirds of the lower lid .
• Periorbital edema and
lichenification or darkening
under the eyes (‘allergic shiners’)
may seen.
Palmoplantar hyperlinearity
• Increased prominence
of palmar and plantar
creases may be seen in
AD patients, particular
those with associated
ichthyosis vulgaris
Pityriasis alba
• Infants and children with
AD may have patches of
hypopigmentation with
fine scale, most commonly
on the face. Such lesions
are more noticeable in
darkly pigmented children
Cheilitis
• Dry, crusty, ‘chapped’ lips
or fissuring of the
commisures (angular
cheilitis) is more
common in infants and
children with AD than in
adults
Lichenification
• results from repeated
rubbing and scratching
• the skin becomes
thickened and leathery
with exaggerated skin
markings.
• Early dermatologists
called AD an ‘itch that
rashes’, referring to the
cutaneous changes that
result from chronic
rubbing and scratching.
Prurigo nodularis
• Multiple intensely
and pruritic nodules
occurring chiefly on
the extremities
(especially the
anterior surfaces of
the thighs and legs)
COMPLICATIONS
Secondary infection
with S. aureus
Rarely •
•
Keratoconjunctivitis
with secondary
herpetic infection and
corneal ulcers.
DIAGNOSIS
Important
features
(support)
Associated
features
(helpful, less
specific)
Essential features (must present)
Pruritus
Eczematous changes
• Typical morphology and age-specific distribution patterns:
• Facial, neck and extensor involvement in infants and
children
• Current or prior flexural lesions in any age group
• Sparing of groin and axillary regions
Xerosis
Associated features (helpful, less specific)
Perifollicular accentuation/lichenification/prurigo
Ocular/periorbital changes
Perioral/periauricular lesions
The UK refinement diagnostic
criteria for atopic dermatitis
In order to qualify as a case of atopic dermatitis
with the UK diagnostic criteria, the child must have:
Early stages of
Nummular eczema dermatophytosis, mycosis
fungoides.
ICD ACD
SEBORREHIC
PSORAIASIS
DERMATITS
TREATMENT
Primary Prevention
• Allergen avoidance during pregnancy, infancy, or
both. Such investigations have typically focused
on dietary allergens (particularly cow’s milk and
eggs) and dust mites.
2) Hydroxyzine, 10–100 mg
four times daily for pruritus.
TOPICAL
SYSTEMIC
PHOTOTHERAPY
ADVANCED TTT
TOPICAL
Emollients
Topical steroids
topical calcineurin
inhibitors (TCIs)
Emollients
Individually adapted
emollients containing
urea (4% in children;
up to 10% in adults)
should be used to
support the skin
barrier function and
allow hydration of
the skin.
Topical steroids
Principles of treatment with topical corticosteroids.
In primary care,
avoid using potent
Be wary of repeat
and very potent
steroids for children prescriptions
with atopic eczema
Topical calcineurin inhibitors (TCIs)
SYSTEMIC
GLUCOCORTICOIDS
ANTIMICROBIALS
ANTI- HISTAMINIC
CYCLOSPORINE
METHOTREXATE
AZATHIOPRINE
BIOLOGICS
CYCLOSPORINE
Oral cyclosporine at a dose of 1.25 mg/kg per
day is effective in reducing disease extent and
severity as well as improving pruritus, sleep and
quality of life in AD.