questions 5

Atopic Dermatitis

Topic updated on 07/20/17 4:00pm

  • PhotoA young mother brings her 6-month-old child to the pediatrician complaining on a recurrent, erythematous, weeping rash that has appeared several times around the child's cheeks.
  • Atopic dermatitis, or eczema, is a relapsing inflammatory skin disorder common in infancy
  • Characterized by pruritis that often leads to lichenification
    • appears as intercellular edema in the epidermis on skin biopsy
  • Rash is caused by unrestricted scratching of the affected areas
    • presents differently in different age groups
  • Etiology is unclear, though genetic factors are suspected
    • atopy is defined as an inherited predisposition to asthma, allergies, dermatitis
  • Commonly associated with asthma and allergic rhinitis
  • Triggers are nongenetic and can include
    • food
    • climate
    • allergy exposure
    • physical irritants
    • chemical irritants
    • stress
  • Symptoms
    • pruritic rash
    • rhinitis
    • asthma
  • Physical exam
    • rashes present differently in different age groups
    • infants 
      • erythematous, weeping, pruritic rash
      • usually on face, scalp, and diaper areas
    • children
      • dry, scaly, pruritic, excoriated lesions
      • usually around the flexural areas and neck
    • adults
      • lichenification
      • dry, fissured skin
      • usually limited to the hands
  • Diagnosis based primarily on history and presentation
  • Labs
    • may demonstrate mild eosinophilia
    • elevated IgE
  • Contact dermatitis
  • Seborrheic dermatitis
  • Pityriasis rosea
  • Drug eruption
  • Urticaria
  • Cutaneous T cell lymphoma
  • Ichthyosis vulgaris: a autosomal dominant disorder that causes progressively dry, scaly skin with horny plates over the extensor surfaces of the limbs   
  • Medical management
    • prophylactic measures and symptomatic relief
      • use nondrying soaps and moisturizers
        • cool compresses, oatmeal preparations, and oral antihistamines
      • avoid known triggers
    • topical and exposure therapy
      • topical corticosteroids
      • PUVA
      • topical immunomodulators
Prognosis, Prevention, and Complications
  • Prognosis
    • usually recurrent 
  • Prevention
    • avoid known irritants and triggers
  • Complications
    • patients at risk of secondary bacterial and viral infections at site of rash


Qbank (2 Questions)

(M2.DM.8) A 20-year-old man presents to his primary care doctor complaining that his skin looks "scaly." He notes that his skin has become progressively dry and itchy over the past several years, and he is embarrassed about its appearance and doesn't want his skin to progress to the "lizard skin" his father had. Past medical history is significant for asthma and keratosis pilaris. On exam, he is well-appearing with normal vital signs His neck and chest appear as seen in Figure A. What is his most likely diagnosis? Topic Review Topic
FIGURES: A          

1. Atopic dermatitis
2. Psoriasis
3. Contact dermatitis
4. Ichthyosis vulgaris
5. Lichen planus

(M2.DM.12) A 5-month-old male infant presents to your office in January. His mother complains that his cheeks are "red and scaly." She's concerned that they are uncomfortable, since she's noticed him scratching them. The rash has worsened since winter started. Otherwise, he has no medical history. Family history is relevant for asthma and some seasonal allergies. On exam, his cheeks bilaterally are erythematous with erosion, scaling and excoriated papules and plaques. Small, similar appearing patches are also present on his chest. What is the most likely outcome for this condition? Topic Review Topic

1. Spontaneous resolution in 1 month
2. Resolution with topical steroids in 1 month
3. Resolution with antibiotics in 1 month
4. Recurrence, regardless of treatment
5. Recurrence, lessened by antibiotics

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