- Clinical science
skin disease that typically manifests for the first time in early childhood. Although it often improves during adolescence, it may also become a chronic condition that extends into adulthood. ic rmatitis is often associated with other atopic diseases, such as asthma or allergic rhinitis. Although the underlying etiology is not completely understood, genetic components, as well as exogenous and endogenous triggers, are believed to play a role. The main symptoms of ic rmatitis include severe pruritus and dry skin. Primary treatment involves managing the pruritus and moisturizing the skin. Topical steroids and calcineurin inhibitors may be added if treatment with moisturizers is insufficient. In severe cases, systemic therapy with steroids is required. The main complication of ic rmatitis is the development of secondary infections.ic rmatitis (AD) is an inflammatory
- About 10–15% of all children are affected
- Onset of symptoms usually occurs between 3–6 months of age
- Disease often improves with age
Epidemiological data refers to the US, unless otherwise specified.
- Genetics (polygenic inheritance)
- Exposure to indoor dust
- Extremely dry or humid climate
- Emotional stress
- Skin irritation
- Main symptoms: intense pruritus and dry skin
- Infantile AD (age < 2 years)
- Childhood AD (age 2 to 12 years)
- Adult/adolescent AD (age > 12 years)
- Asthma and allergic rhinitis (atopic triad): triad of asthma, allergic rhinitis, and atopic dermatitis that is linked by allergen-triggered IgE-mast cell activation
- Food allergies
- White dermographism: a physical finding of transiently blanched skin after skin stroking.
- Dermatographism: formation of urticaria after minor pressure is applied to the skin, likely mediated by local histamine release.
- Hertoghe sign: thinning or loss of the outer third of the eyebrows
The diagnosis of atopic dermatitis is usually based on patient history and clinical appearance. The American Academy of Dermatology suggests the use of several clinical criteria that need to be fulfilled in order to establish the diagnosis.
- Clinical criteria
- Not part of the diagnostic criteria
- Spongiotic dermatitis: epidermal intercellular edema widening the intercellular space between keratinocytes
- Acanthosis and hyperkeratosis (in chronic eczema)
- ; : Lesions are usually dry in atopic dermatitis and more greasy in seborrheic dermatitis.
- Psoriasis; : onset is generally after adolescent years; lesions are typically covered with white or silvery scales and are commonly located on the extensor surface of extremetities
The differential diagnoses listed here are not exhaustive.
- Avoid triggers:
- Allergic trigger factors (pets, dust mites, pollen, certain foods)
- Irritants (clothing, chemicals)
- Keep the skin moist
- Breast feeding recommended during infancy
- Manage/eliminate stress
Management of AD based on disease severity
|Mild AD||Moderate AD||Severe AD|