Atopic dermatitis

Synonym(s)

Atopic eczema; infantile eczema; Besnier's prurigo

Atrophic parapsoriasis 69

Atopic dermatitis. Lichenified, red plaque with erosions in the antecubital fossa

Definition

Disease starting in early infancy and characterized by pruritus, eczematous lesions, dry skin, and an association with other atopic diseases (asthma, allergic rhinitis, urticaria)

Pathogenesis

Abnormality of T helper type 2 (TH2) cells, resulting in increased production of inter-leukin 4 (IL-4) and increased IgE; stratum corneum lipid defect, leading to increased transepidermal water loss

Clinical manifestation

Marked pruritus, often starting in the first few months of life; asthma or hay fever or a history of atopic disease in a first-degree relative; dry skin; lichenified plaques with epithelial disruption, occurring on the face in infancy, in the flexural creases, trunk, and diaper area by 1 year of age, and over the distal extremities later in life; scalp involvement, usually after age 3 months

Differential diagnosis

Seborrheic dermatitis; contact dermatitis; stasis dermatitis; nummular eczema; scabies; mycosis fungoides; dermatophytosis

Therapy

Mid potency topical corticosteroids*; pred-nisone for temporary therapy of severe flares; pimecrolimus 1% cream; tacrolimus 0.3% or 1% ointment; azathioprine; cyclo-sporine; antihistamines, first generation, for nighttime sedation UVB phototherapy;

photochemotherapy (PUVA); evening primrose oil; Chinese herbs; emollients applied at least twice daily, particularly during the winter months

References

Tofte SJ, Hanifin JM (2001) Current management and therapy of atopic dermatitis. Journal of the American Academy of Dermatology 44(1 Sup-pl):Si3-i6

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