Atopic Dermatitis

  • A chronic, immune-mediated, pruritic, inflammatory skin condition seen in atopic individuals.
  • Marked by alternating periods of remission and flare-ups.
  • A result of complex interplay between environmental, immunologic, genetic and pharmacologic factors.
  • Aggravated by infection, psychological stress, seasonal changes, irritants, and allergens.
Atopic Dermatitis

Clinical features

  • Age of onset typically during infancy (2 to 6 months); but may start at any age.
  • Clinical features vary at different phases of life; and comprise:
  • Itching
  • Macular erythema, papules or papulo-vesicles
  • Eczematous areas with crusting
  • Lichenification and excoriation
  • Dryness of the skin
  • Cutaneous reactivity
  • Secondary infection
  • Asthma and hay fever
  • Chronic itchy, scaly skin
  • Skin infections
  • Irritant hand dermatitis
  • Allergic contact dermatitis
  • Sleep problems

Mutation in FILAGGRIN gene responsible for holding skin moisture

  • Moisturize your skin atleast twice a day
  • Try to identify and avoid triggers that worsen the condition
  • Take shorter baths
  • Tak e a bleach bath
  • Use only gentle soaps
  • Dry yourself carefully
  • Anxiety; emotional stress
  • Temperature change and sweating
  • Decreased humidity
  • Excessive washing
  • Contact with irritants
  • Allergens
  • Foods
  • Microbial agents

How is it diagnosed?

  • Hannifin and Rajki Criteria
  • Diagnostic criteria: Major features
    • Pruritus.
    • Typical morphology and distribution - Facial and extensor involvement in infants and children, flexural lichenification in adults.
    • Chronic or relapsing dermatitis.
    • Personal or family history of atopy (atopic dermatitis; asthma; allergic rhinitis).
Diagnostic criteria: Minor features
  • Xerosis
  • Ichthyosis, palmar hyperlinearity, or keratosis pilaris
  • Immediate (type 1) skin-test reactivity
  • Raised serum IgE
  • Early age of onset
  • Tendency toward cutaneous infections (especially S aureus and herpes simplex) or impaired cell-mediated immunity
  • Tendency toward non-specific hand or foot dermatitis
  • Nipple eczema
  • Cheilitis , Recurrent conjunctivitis
  • Dennie-Morgan- infraorbital fold
  • Keratoconus
  • Anterior subcapsular cataracts
  • Orbital darkening
  • Facial pallor or facial erythema
  • Pityriasis alba
  • Anterior neck folds
  • Itch when sweating
  • Intolerance to wool and lipid solvents
  • Perifollicular accentuation
  • Food intolerance
  • Course influenced by environmental or emotional factors
  • White dermographism or delayed blanch
Atopic Dermatitis

How is it treated?

Identify and control ‘flare factors’

  • Bathing; Emollients; Humectants
  • Corticosteroids
  • Calcineurin inhibitors : Pimecrolimus; tacrolimus
  • Icthamol and tar

  • Antihistamines
  • Sedative antihistamines preferred
  • Promethazine; trimeperazine; hydroxyzine
  • Antibiotics
  • Systemic steriods (in severe cases)

  • Intensive topical therapy- step up to potent steroid
  • Wet wrap technique
  • Allergy management
    • Food
    • Inhalants
    • Contact allergy

  • Phototherapy
  • Oral immunosuppresants
  • Allergy management
    • Cyclosporine
    • Azathriopine
    • Thymopentine
    • α- Interferon
    • Desensitization

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