Professional Documents
Culture Documents
I. Epidemiology and Pathogenesis pediatric age group approaches 5%, maybe even as high as 10%
in children between the ages of five and 10 years. Ninety five
A. Atopic dermatitis has an incidence of 7/1,000 and a prevalence of 3-5% of
percent of all patients will have their first outbreak by age five. It
children.
is extremely unusual for patients to have their first manifestation
B. 95% of affected children will have symptoms by age 5.
after 10 years of age, which is important when you consider a
C. The inheritance pattern is multifactorial. number of other dermatitic processes that may present with skin
D. Pathogenesis is related to immunologic factors, histamine and vasoactive lesions that look very much like atopic dermatitis. After the age of
mediators. 10, think of other things in your differential diagnosis. And
Major criteria (all required Common findings (at Associated findings (at In acute dermatitic processes, one sees erythema, vesicles,
for diagnosis) least two) least four) crusting. You may see secondary infection. If the patient has a
flare of their atopic dermatitis, you will see acute changes in the
Pruritus Personal or family history Ichthyosis, xerosis,
skin. Patients with chronic changes will have lichenification or
Typical morphology and of atopy hyperlinear palms
accentuation of the normal skin margins with thickening of the
distribution of rash Immediate skin test Pityriasis alba
epidermis. These patients will have excoriation and pigmentary
reactivity Keratosis pilaris
change. They will have scale. These changes suggest a process
White dermographism Facial pallor, infraorbital
which has been ongoing for days if not weeks or months. Again,
Anterior subcapsular darkening
you can see this in association with the acute changes when the
cataracts Dennie-Morgan folds
patient has acute flares of their atopic disease.
Keratoconus
Hand dermatitis
Age related patterns will help you make the diagnosis. In infancy,
Repeated cutaneous
all areas of the skin fair game for presentation of the skin lesions
infections
with the exception of protected areas. The diaper area is
invariably spared until the patients are toilet-trained. Then you
Relative Greasiness of Common Skin Lubricants start to see lesions in the diaper area and this is a reliable finding.
Widespread disease affects the head and neck, the extremities.
Lubricant Greasy-ness
The trunk may be relatively spared because it is a relatively
Petrolatum More Greasy protected site. This child has both some acute changes of
Aquaphor ointment base erythema and scaling and crusting. This child has some chronic
changes and lichenification. In fact, in this age group, it is probably
Mineral oil
more common to see involvement over the extensor surfaces of
Eucerin cream
the arms and legs because the flexural creases are actually
Keri lotion
relatively spared sites. So in this age group, you expect to see
Lubriderm lotion exactly the opposite of what you see in a slightly older child. The
Cetaphil lotion scalp is a common area of involvement. Certainly, in younger
LactiCare lotion infancy, you see seborrhea, but if it is seborrheic dermatitis, it
Moisturel skin lubricant-moisturizer doesn't itch and if it itches you need to consider the possibility of
3. Chronic fungal infection acute and chronic dermatitis here. Lichenification is symmetric
crusting pruritus is commonly involved and this area can be
I. Differential Diagnosis
thought of as being one of the flexural creases that you typically
1. Seborrheic dermatitis
see in school-aged children.
2. Irritant dermatitis
3. Papular acrodermatitis In teenagers and adults, flexures tend to be involved
5. Fungal infection 90%, of children will have their disease go into remission in the
late school-aged years or adolescent years. But certainly there
6. Scabies
are some patients who have persistent disease. There are many
J. Treatment of Atopic Dermatitis
patients who will go into remission only to have recurrence of their
1. Lubricants
lesions when they get involved in occupations or hobbies that
2. Brief, regular bathing. Use of mild oaps expose them to irritants.
3. Topical steroid
4. Environmental control measures Hand dermatitis with chronic dermatitis, thickening of the skin,
5 Triamcinolone acetonide Aristocort cream 0.1% Ichthyosis vulgaris. This can certainly occur again as an
Flurandrenolide Cordran SP cream 0.05%
independent entity. It usually does not present until after six
Fluonide cream 0.01%
months of age, so it should not be confused with some of the
Fluocinolone acetonide Kenalog cream O. 1%
other ichthyoses that can present with devastating effect in the
Triamcinolone acetonide Synalar cream D.01%
Fluocinolone acetonide Valisone cream 0.1% newborn period. Typically on the distal extremities. The most
Betamethasone valerate Westcort cream 0.2% common sites would be just the lower extremities, the shins.
Hydrocortisone valerate These patients may have hyperlineary of the palms and soles.
They may have keratosis pilaris. These thorny little sand-papery-
like papules in the back of the upper arms, cheeks and thighs
If you have a patient with an acute process and you give them a
water-based product, it may sting and burn. So, it is important that
you consider the vehicle. If you have a patient that develops some
sort of an adverse reaction to the topical preparation, in may in
fact not be the medicated product at all. It may be one of the
components of the vehicle. So you need to look carefully at the
"inert" ingredients.