Atopic Dermatitis

ATOPIC DERMATITIS
BY By DR SAAD I ALMOHIZEA Dr saad I. almohize OCTOBER 2004 SFH

ATOPIC DERMATITIS

Atopy? Prevalence is 10% in children and 1% in the adult population Rising AD may be more common among Caucasian and Chinese persons, but it affects all races. Sex: The male-to-female ratio is 1:1.4. Age: In 85% of cases, AD occurs in the first year of life, and in 95% of cases, it occurs before age 5 years.

criteria

Major 1.pruritus 2.typical morhology and distribution 3.chronicity 4.family history of atopy

Minor criteria

Xerosis Icthyosis/hyperlinear palms/keratosis p. IgE reactivity Elevated IgE level Early onset Skin infection Chelitis Nipple eczema

Recurrent conjuctivitis Keratoconus Dennie morgan fold Anterior c. cataract Orbital darkening Facial erythema Pityriasis alba Food hypersensitivity White dermatographism

SKIN INFECTIONS
STAPH AURIOUS: 1.folliculitis 2.impetigo HSV SMALL POX TRICHOPHYTON RUBRUM MALASSEZIA FURFUR

PHYSICAL

Infancy xerosis, often spares the diaper area. folds (antecubital and popliteal fossae). The appearance is erythematous with exudative patches. Over a few weeks, lesions localize to the cheeks and forehead and extensors of the lower legs but may occur on any location on the body. The scalp is dry and flaky. Lichenification is not seen often in infancy.

PHYSICAL

Childhood Xerosis often is generalized. Lesions are eczematous and exudative. Often, pallor of the face is noted, with erythema and crusting around the eyes. Flexural creases most often are affected, including the antecubital and popliteal fossae and buttockthigh crease. Excoriations and crusting are common LESS WEEPY

PHYSICAL

Adulthood Lesions become more diffuse with an underlying background of erythema. The face commonly is involved. Dryness is prominent. Lichenification is present. A brown ring around the neck is typical but not always present

Causes

chromosome 11q13 or 5q31. colonization by S aureus. AD flares in extremes of climate. Heat is poorly tolerated, as is extreme cold. A dry atmosphere increases dry skin. Sun exposure improves lesions, but sweating increases pruritus. The role of food ?? role for aeroallergens and house dust mites??. autoallergens

Pathophysiology

IL4 /IL5/ IL10 are all increased Laboratory findings suggest an abnormality of T helper 2 (TH2) cells resulting in increased production of interleukin 4 (IL-4) and increased IgE. The excess IL-4 causes decreased interferon g levels. Cells may react with environmental antigens to produce increased levels of IgE. Serum histamine is increased stratum corneum abnormalities of lipid (particularly ceramide production). abnormality of prostaglandin metabolism

Differential diagnosis
Contact dermatitis Ataxia-telangiectasia syndrome Histiocytosis X Lichen simplex chronicus Photosensitivity rashes Psoriasis Wiskott-Aldrich syndrome Seborrheic dermatitis Mycosis fungoides scabies Ichthyosis vulgaris

workup

Laboratory testing is seldom necessary. Allergy testing is of little value. Radioallergosorbent assay is of little value. Food challenge/elimination diet Perform CBC for thrombocytopenia to exclude Wiskott-Aldrich syndrome. T-cell markers to exclude immunodeficiency Scraping to exclude tinea corporis Histologic Findings: Biopsy shows an acute, subacute, or chronic dermatitis, but no specific findings are demonstrated.

treatment

Moisturization Topical steroids UV light: UV-A, UV-B, NBUVB Antihistamines: Ketotifen Oil of evening primrose Antibiotics (cloxacillin or cephalexin) Ascomycin Tacrolimus (topical FK506) methotrexate and cyclosporine