Details Descriptions About :: Atopic Dermatitis

 Atopic (allergic) dermatitis (also called atopic or infantile eczema) is a chronic or recurrent inflammatory response commonly associated with other atopic diseases, such as bronchial asthma and allergic rhinitis. Age Alert Atopic dermatitis commonly develops in infants and toddlers between ages 1 month and 1 year, usually in those with a strong family history of atopic disease. These children commonly develop other atopic disorders as they grow older. Typically, this form of dermatitis flares and subsides repeatedly before finally resolving during adolescence, but it can persist into adulthood.

Causes for Atopic Dermatitis

Causes Exact etiology unknown; genetic predisposition likely Possible contributing factors Food allergy, especially eggs, peanuts, milk, or wheat Infection Chemical irritants Extremes of temperature and humidity Psychological stress or strong emotions

Pathophysiology Atopic Dermatitis

Pathophysiology The allergic mechanism of hypersensitivity results in a release of inflammatory mediators through sensitized antibodies of the immunoglobulin (Ig) E class. Histamine and other cytokines induce acute inflammation. Abnormally dry skin and a decreased threshold for itching set up the “itch-scratch-itch” cycle, which eventually causes lesions (excoriations, lichenification).

Signs and symptoms Atopic Dermatitis

Signs and symptoms Erythematous areas on excessively dry skin; in children, typically on the forehead, cheeks, and extensor surfaces of the arms and legs; in adults, at flexion points (antecubital fossa, popliteal area, and neck) Edema, crusting, scaling caused by pruritus and scratching Multiple areas of dry, scaly skin, with white dermatographism, blanching, and lichenification with chronic atrophic lesions Infantile form presents as red skin with tiny vesicles, especially on the face (sparing the mouth); possible development of wet crusts and fissures In blacks, follicular eczema common, appearing as discrete follicular papules involving hair follicles in the affected area Pinkish, swollen upper eyelid and double fold under lower lid Viral, fungal, or bacterial infections and ocular disorders possible secondary conditions

Diagnostic Lab Test results

Diagnostic test results Blood tests reveal eosinophilia and elevated IgE levels.

Treatment for Atopic Dermatitis

Treatment Eliminating allergens and avoiding irritants (strong soaps, cleansers, and other chemicals), extreme temperature changes, and other precipitating factors Preventing excessive dryness of the skin (critical to successful therapy) by maintaining adequate fluid intake, taking tepid baths, and humidifying air Topical tar preparations in a lubricating base (contraindicated for intensely inflamed or open lesions) Topical corticosteroid ointment, especially after bathing, to alleviate inflammation; moisturizing cream between steroid doses to help retain moisture Topical doxepin hydrochloride Topical immunomodulators, such as tacrolimus and pimecrolimus Systemic antihistamines such as diphenhydramine Systemic corticosteroid therapy for severe disease only Ultraviolet B or psoratens plus ultraviolet A therapy In severe adult-onset disease, cyclosporine A, if other treatments fail Antibiotics, if skin culture positive for bacteria Clinical Tip Morgan’s line In children with atopic dermatitis, severe pruritus with recurrent rubbing leads to characteristic pink pigmentation and swelling of the upper eyelid and a double fold under the lower lid (Morgan’s line, Dennie’s sign, or mongolian fold).

 

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