Atopic Dermatitis - picture, treatment, symptom of Atopic Dermatitis

Atopic dermatitis looks different at different ages and in people of different races. Because most patients have scaly dry skin at some point, this disease is being discussed under scaly dermatoses. However, acute flares may present with red patches that are weepy, shiny, or lichenified (ie, thickened, with more prominent skin markings) and plaques and papules.

Diagnostic criteria for atopic dermatitis must include pruritus, typical morphology and distribution (flexural lichenification in adults), and a tendency toward chronic or chronically relapsing dermatitis. Also helpful are

(1) a personal or family history of atopic disease (asthma, allergic rhinitis, atopic dermatitis),
(2) xerosis-ichthyosis,
(3) facial pallor with infraorbital darkening,
(4) elevated serum Ige,
(5) fissures under the ear lobes,
(6) a tendency toward nonspecific hand dermatitis,
(7) a tendency toward repeated skin infections, and
(8) nipple eczema.

Clinical Findings of Atopic Dermatitis

Symptoms and Signs of Atopic Dermatitis

Itching may be severe and prolonged. The main symptom of Atopic Dermatitis are rough, red patches usually without the thickening and discrete demarcation of psoriasis (see photograph) affect the face, neck, and upper trunk ("monk's cowl"). The bends of the elbows and knees are involved. In chronic cases, the skin is dry, leathery, and lichenified (see photograph). Pigmented persons tend to present with a papular eruption, and poorly demarcated hypopigmented patches (pityriasis alba) are commonly seen on the cheeks and extremities in Atopic Dermatitis. In black patients with severe disease, pigmentation may be lost in lichenified areas.

Treatment of Atopic Dermatitis

Treatment of Atopic Dermatitis is most effective if the patient is instructed about the general principles of skin care and exactly how to use medications.

General Measures for the treatment of Atopic Dermatitis

Atopic patients have hyperirritable skin. Anything that dries or irritates the skin will potentially trigger dermatitis. Atopic individuals are sensitive to low humidity and often get worse in the winter, when the air is dry. Adults with atopic disorders should not bathe more than once daily. Soap should be confined to the armpits, groin, scalp, and feet. Washcloths and brushes should not be used. Soaps should not be drying, and Dove, Eucerin, Aveeno, Basis, Alpha Keri, Purpose, and other soaps or cleansers, such as Cetaphil or Aquanil, may be recommended. After rinsing, the skin should be patted dry (not rubbed) and then immediately—within three minutes—covered with a thin film of an emollient such as Aquaphor, Eucerin, Vaseline, or a corticosteroid as needed. Triceram cream, a therapeutic moisturizer, will reduce inflammation as well as moisturize without a greasy or occlusive feel. It is much more expensive than traditional moisturizers. Atopic patients may be irritated by scratchy fabrics, including wools and acrylics. Cottons are preferable, but synthetic blends also are tolerated. Other triggers of eczema in some patients include sweating, ointments, hot bathing, and animal danders.

Laboratory Findings of Atopic Dermatitis

Food allergy is an uncommon cause of flares of atopic dermatitis in adults. Blinded food challenges are the most reliable method of diagnosing suspected food allergy. RASTs or skin tests may suggest dust mite allergy. Eosinophilia and increased serum IgE levels may be present but are nonspecific.

Differential Diagnosis of Atopic Dermatitis

Atopic dermatitis must be distinguished from seborrheic dermatitis (less pruritic, frequent scalp and face involvement, greasy and scaly lesions, and quick response to therapy). Contact dermatitis (see photograph) and impetigo may be in the differential, especially for hyperacute, weepy flares of atopic dermatitis (although typically these diseases do not have a chronic course and characteristic distribution). Patients with active lesions are almost always colonized with Staphylococcus aureus, and impetiginization of atopic skin should be considered and treated when the patient presents with an acute flare

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