Atopic Dermatiis

Question 1

When does AD start and what is the pattern

Answer 1

Usually starts 3-4/12 of age
Usually starts on the face and then spreads to the body
Spares the nappy region
Flexures may not be involved till 2 years
Ofen improves by 2 or continues

Question 2

Explain the pathogenesis of atopic dermatitis

Answer 2

Genetic predisposition defective barriers
Environmental factors 
 Environmental triggers ALL PATIENTS
 Infection HSV,staph strep ALL PATIENTS
Allergens food airborne 20-30% of pt
Food intolerance. Some pt

Question 3

Typical environmental triggers in atopic dermatitis

Answer 3

Drying agents eg water soap chlorine 
Abrasive clothing. Wool nylon
Abrasive surfaces carpet lambs wool covers sandpit
Heat 
Chemicals eg perfume

Question 4

Staph a infection can exacerbate the inflamation and reduce the effectiveness of the steroids how do you treat the staph skin infection

Answer 4

Antibacterial bath oil and bleach baths

In severe cases once daily Bactria

Question 5

Treatment of atopic dermatitis

Answer 5

Avoid the environmental irritants
Topical steroid cream or if severe facial eczema tacrollimus
Treat any infection bleach baths
Review in 6-8 weeks time

Question 6

Dd of atopic dermatitis

Answer 6

Scabies
Psoarisis
Militarization

Question 7

Atopic dermatitis And allergy
History 4
Examination 3

Answer 7

History 
Exacerbation with exposure ie when has egg custard gets worse
Fluctuating history marked redness
History of nocturnal itch. HDM
History of constant steroid use

Examination
Pronounced redness white dermatographism
Pattern of facial involvement eg around eyes and on forehead HDM
Extent and distribution of the excess

Question 8

Food allergies and atopic dermatitis

Answer 8

Can be ingested via breast milk, solids or formulae
Most significant in first 1-2 years
Eggs and nuts >cows milk> wheat
RAST and SPT

Question 9

Food intolerance

Answer 9

Is not allergic
Redness around mouth and around anus irritates on the way in and on the way out
Strawberries tomatoes

Question 10

House dust mite and atopic dermatitis

Answer 10

Nocturnal itch

Rash is around eyes periorbital and on forehead

Question 11

Atopic dermatitis anti inflataory treatmetns

Answer 11

Topical steroids and +/- wet dressings 10 days on 4 days off
2 tacrolimus
3 phototherapy
4 oral immunosuppressive older pt MTX