Dr.

Roaa Session – Part 3

Atopic dermatitis is either: acute, subacute or chronic.

Acute type has erythema, weeping, vesiculation and crustations.
In chronic type there will be thickened skin, excessive skin markings and dryness
(lichenification).
Atopic dermatitis according to age: infantile type (starts at 2 months to 2 years),
childhood type and adult type.

The picture shows the acute type with presence of

erythema, weeping and crustations.
Atopic dermatitis in infants usually found on the
cheek, the body and extensor surface with sparing
of the nasolabial folds, groin and the axilla. Which is
important to differentiate it from seborrheic
dermatitis.

This picture shows diffuse erythema with

crustations on the cheek.
Acute atopic dermatitis with weeping, erythema and
crustations. Notice the sparing of the nasolabial
folds.

This child presents with pruritus and itching.

Description: diffuse erythema with scaling involving
the whole body with sparing of the groin area.
Note: atopic dermatitis in infants is usually after 2
months while seborrheic dermatitis develops in the
first 2 months.

This picture shows childhood type atopic dermatitis.

Ill defined erythema with scaling and fissuring on the
flexor area. Scratching marks are also present.

Note: in childhood and adult dermatitis it is usually

on the flexor surface while the infantile type is on
the extensor surface, cheek and body.
This looks more like a subacute type, less weeping
with crustations and thickening.

Erythematous area with small crustations on the

chin.

Notice the sparing on the central face.

Pityriasis alba.
Multiple ill defined hypopigmented patches. It is
usually present on the face.
This condition maybe associated with atopic
dermatitis.
DDx: Post inflammatory hypopigmentation,
pityriasis versicolor, vitiligo

Notice this child itching with involvement of the face

and the extensor surface.
DDx for atopic dermatitis: seborrheic dermatitis,
scabies.

Erythematous, ill defined, thickened, crusted patches.

Erythematous patch with multiple erosions due to
excessive scratching in the flexural area.
Atopic dermatitis.

Atopic dermatitis in adults is usually hand, eyelid

dermatitis.
Ill defined erythematous patch with erosions.

Hyperkeratotic thickened skin with excessive markings

due to excessive itching (lichenification).

Ill defined hypopigmented patches.

Pityriasis alba.
Eczema herpetica.
Multiple erosions, hemorrhagic crustations,
disseminated.

Same as above.

Treatment of atopic dermatitis: moisturization is the most important step because

these children have a barrier defect which causes loss of water and dryness.
Emollients are also used. You should also educate and instruct the patient to use
moisturization and decrease swimming to avoid dryness of the skin.
Topical steroids, calcineurin inhibitors. Systemic steroids, immunosuppressive
drugs.

Contact dermatitis

Contact dermatitis due to application of neomycin

ointment.
Well defined, irregular border erythematous patch
with small vesicles.
Acute dermatitis. Contact allergic dermatitis.
There is edema, multiple vesicles with area of
crustation in the center.

Contact dermatitis due to nickel.

Ill defined erythematous scaly lesion on the ear.
Very important

Allergic contact dermatitis due to potassium

dichromate.
Well defined, irregular border, erythematous patch
with erosions.
Well defined, erythematous patch
due to underwear (rubber, latex).
Important

Contact dermatitis due to watch.

Allergic contact dermatitis.

Nickel dermatitis that is present in the belt. Multiple
erosions.
Important

Erythematous, with multiple vesicles.

Allergic contact dermatitis.

Thickened, fissuring. Could be contact dermatitis.

Important ddx is tenia especially if it is on one hand.
Treatment of contact dermatitis: Avoid the cause, Topical steroid, anti-histamine.

Pompholyx (Vesicular dermatitis)

Multiple deep-seated vesicles, it is usually on the

palm and lateral side of the finger.

Multiple deep-seated pustules and vesicles on the

palm and fingers.
DDx: Psoriasis, tenia, acropustulosis of infancy.
Treatment: Topical steroid
 Seborrheic dermatitis

‫انقطع النت‬

Seborrheic dermatitis.
Notice the involvement of the lateral nose and eyebrows.

Seborrheic dermatitis.
Yellowish greasy scaling with fissuring behind the ear.
Seborrheic dermatitis, notice the involvement of the lateral
nose and eyebrows with yellowish greasy crustations.

There is erythema with yellowish greasy scaling involve the

face and lateral nose.
Important

In adult males, seborrheic dermatitis may involve the

chest in a petaloid appearance.

Treatment of seborrheic dermatitis: Olive oil to remove the crustations, topical

anti-fungal.
 Discoid Dermatitis

Multiple coin shaped erythematous, weepy patches with

crustations.

Discoid, coin shaped, weepy.

DDx: tenia corporis, psoriasis, herald patch of pityriasis

rosea.
Treatment: Topical steroid, anti-histamine.
Candida, folds are involved, satellite lesions or daughter lesions
are present.

Irritant dermatitis or napkin dermatitis usually involves

contact areas with sparing of the folds.

Prurigo nodularis papulo-nodular lesion, severely itchy and

maybe associated with atopic dermatitis.

Keratosis pilaris Perifollicular papules and each one is

surrounded by a rim of erythema also associated with
atopic dermatitis.
Treatment: topical keratolytic agent like topical retinoid.

Chronic dermatitis thickened hyperkeratotic

erythematous.