22: Atopic Dermatitis Flashcards
What are the major features of Atopic Dermatitis (AD)?
The major features of Atopic Dermatitis (AD) include:
- Pruritus
- Eczematous dermatitis (acute, subacute, or chronic) with typical morphology and age-specific patterns
- Facial and extensor involvement in infancy
- Flexural eczema or lichenification in children and adults
- Common associations include personal or family history of atopy, xerosis or skin barrier dysfunction, and immunoglobulin E reactivity.
What is the prevalence of Atopic Dermatitis in children in the US and other industrialized countries?
The prevalence of Atopic Dermatitis (AD) in children is estimated to be between 10% to 20% in the US, Northern and Western Europe, Japan, Australia, and other industrialized countries. There is a noted female preponderance for AD with a female to male ratio of 1.3 to 1.0. Additionally, African Americans have a higher prevalence of the disease in the United States.
What are the cutaneous findings associated with Atopic Dermatitis?
The cutaneous findings associated with Atopic Dermatitis (AD) include:
- Acute eczematous lesions: erythematous papulovesicles, often with pinpoint crusting or frank weeping.
- Subacute to chronic lesions: scale, excoriation, and lichenification.
- Darker skin tones: follicular accentuation, flat-topped papules in lichenified areas, and a tendency toward hyperpigmentation in inflamed areas.
- Patients may present with a mixture of both acute and chronic lesions in multiple areas of the body simultaneously or even in the same lesion.
What psychosocial impacts are associated with Atopic Dermatitis in children and adults?
The psychosocial impacts associated with Atopic Dermatitis (AD) include:
- In children: Higher prevalence of ADHD, anxiety, conduct disorder, and autism, with the risk of ADHD mediated by sleep disturbance due to pruritus.
- In adults: Increased levels of anxiety and depression. Antiinflammatory therapy can help alleviate both anxiety and depression symptoms in adults.
What are some common atopic comorbidities associated with Atopic Dermatitis?
Common atopic comorbidities associated with Atopic Dermatitis (AD) include:
- Allergic rhinitis
- Asthma
- Food allergies
- Eosinophilia
- High levels of total and specific serum IgE
- Predisposition toward allergic comorbidities
AD is often the first atopic disease to develop, but these diseases can occur in any order and in any combination.
What diagnostic criteria should be used to confirm atopic dermatitis?
The Hanifin-Rajka criteria, which include pruritus, eczematous dermatitis with typical morphology and age-specific patterns, and a personal or family history of atopy, should be used to confirm atopic dermatitis.
What are the major clinical features of atopic dermatitis (AD) in children and adults?
The major clinical features of atopic dermatitis (AD) include:
1. Pruritus
2. Eczematous dermatitis (acute, subacute, or chronic) with typical morphology and age-specific patterns
3. Facial and extensor involvement in infancy
4. Flexural eczema or lichenification in children and adults
5. Common associations include personal or family history of atopy, xerosis or skin barrier dysfunction, and immunoglobulin E reactivity.
How does the prevalence of atopic dermatitis (AD) vary by demographic factors such as age, gender, and ethnicity?
The prevalence of atopic dermatitis (AD) varies by several demographic factors:
- Age: Prevalence in children is between 10% to 20%.
- Gender: There is a female preponderance for AD with a ratio of 1.3:1 (F:M).
- Ethnicity: African Americans have a higher prevalence of AD in the United States compared to other ethnic groups.
- Geographic Location: Higher prevalence is noted in rural settings compared to urban centers within the same country.
What are the non-cutaneous findings associated with atopic dermatitis (AD) and their clinical significance?
Non-cutaneous findings associated with atopic dermatitis (AD) include:
1. Atopic Comorbidities: Signs of T helper 2 (Th2) immune activation such as high levels of total and specific serum IgE, eosinophilia, and predisposition toward allergic comorbidities. Higher prevalence of food allergies, asthma, and allergic rhinitis.
2. Psychosocial Impact: Increased risk of mental health issues, including anxiety and depression, particularly in adults.
What is the most common bacterial infection found in atopic dermatitis (AD)?
The most common bacterial infection found in AD is superficial Staphylococcus aureus infections.
What role do type 2 cytokines play in atopic dermatitis regarding Staphylococcus aureus infections?
Type 2 cytokines augment the killing effect of Staphylococcus aureus toxins on keratinocytes and their blockade appears to reduce skin infections in AD.
What is eczema herpeticum and what are its potential complications in atopic dermatitis?
Eczema herpeticum (EH) is a serious viral complication characterized by multiple itchy, vesiculopustular lesions that can become hemorrhagic and crusted. It may lead to large, denuded areas that can be fatal in some cases.
What are the ocular problems commonly associated with atopic dermatitis?
Common ocular problems associated with AD include eyelid dermatitis, chronic blepharitis, atopic keratoconjunctivitis, and vernal conjunctivitis. These can lead to visual impairment and other disabling symptoms.
What is the significance of using dilute sodium hypochlorite baths in the management of atopic dermatitis?
The use of dilute sodium hypochlorite baths (bleach baths) appears to improve the severity of atopic dermatitis by reducing Staphylococcus aureus colonization.
What are the potential consequences of eczema vaccinatum in patients with atopic dermatitis?
Eczema vaccinatum can cause a severe widespread eruption resembling eczema herpeticum in patients with AD, particularly if they are exposed to vaccinated individuals.
What is the relationship between hand dermatitis and atopic dermatitis?
Hand dermatitis is often nonspecific and can be aggravated by repeated wetting and washing with harsh soaps, leading to occupational disability in atopic individuals.
What are the potential triggers for exfoliative dermatitis in patients with atopic dermatitis?
Exfoliative dermatitis can be triggered by superinfection with toxin-producing Staphylococcus aureus, herpes simplex infection, or withdrawal of topical/systemic glucocorticoids used to control severe AD.
What immunological factors contribute to susceptibility to Staphylococcus aureus infections in atopic dermatitis?
Factors include blunted antimicrobial peptide expression, elevated pH, and disrupted skin barrier, which promote Staphylococcus aureus growth.
What is the most likely secondary complication for a patient with atopic dermatitis who has honey-colored crusting on their lesions?
The honey-colored crusting suggests a secondary bacterial infection, likely caused by Staphylococcus aureus. Management includes the use of antistaphylococcal antibiotics such as cephalosporins or penicillinase-resistant penicillins.
What occupational factors should be considered for a patient with persistent hand eczema despite treatment?
Occupational factors such as repeated hand wetting, exposure to harsh soaps, detergents, and disinfectants should be considered as they can aggravate hand dermatitis.
What is the likely diagnosis for a patient with atopic dermatitis who develops severe erythroderma and systemic toxicity?
The likely diagnosis is exfoliative dermatitis, which could be triggered by superinfection, inappropriate therapy, or withdrawal of topical/systemic glucocorticoids.
What are the implications of Staphylococcus aureus colonization in patients with atopic dermatitis (AD)?
Staphylococcus aureus colonization in AD can lead to skin inflammation, as its toxins activate antigen presenting cells and increase T-cell cutaneous lymphocyte antigen (CLA) expression. This contributes to the severity of AD flares and is associated with a shift in the microbiome towards higher proportions of S. aureus.
How does eczema herpeticum (EH) present in patients with atopic dermatitis, and what are the potential complications?
Eczema herpeticum presents as multiple itchy, vesiculopustular lesions that can cluster and become hemorrhagic and crusted. Complications include painful erosions that may coalesce into large, denuded areas, potentially leading to severe systemic effects and even fatal outcomes in some cases.
What are the common ocular problems associated with atopic dermatitis, and how can they impact patients?
Common ocular problems in atopic dermatitis include eyelid dermatitis, chronic blepharitis, and atopic keratoconjunctivitis, which can cause symptoms like itching, burning, and tearing. These conditions may lead to visual impairment and require careful management to prevent complications such as corneal scarring.