Atopic Dermatitis

Question 1

Cause

Answer 1

Unknown. Atopic cluster- asthma, eczema, hay fever-> genetic basis.

Question 2

Signs/symptoms

Answer 2

Red scaly eruption.
Acute- weeping and crusted.
Chronic- thickened with weeping and cracking.

Question 3

Affected areas

Answer 3

Infants- face and nappy area
Children- flexures, hands and feet.
Adults- flexures, hands, feet, elbows.

Question 4

General info

Answer 4

Worse in winter, heat/sunlight may precipitate it, predisposition to contact dermatitis, issue in infancy which settles with age, may be an issue in adulthood- external irritants. Relapses decrease with age.

Question 5

Issues

Answer 5

Secondary infection may occur. Bacterial (staph aureus) or viral (warts, herpes, molluscum).

Question 6

Treatment

Answer 6

Avoid precipitating factors, esp soaps!

Use soap substitutes- QV, Dermaveen, Aveeno, Alpha-Keri. Stop skin from drying out.

Emollients-BD-TDS, prevent relapse and acute management. Drier the skin the thicker the emollient. Oatmeal helps if itch. Avoid tar bases.

Astringents and antiseptics for inflammatory disease- reduce weeping and risk of infection

Question 7

Treatment- Corticosteroids

Answer 7

Topical and systemic.
Not for use if infection already present, may worsen.
Topical agent picked due to site not condition.

Question 8

Corticosteroids MILD

Answer 8

Desonide 0.05%, hydrocortisone/hydrocortisone acetate 0.5%/1% for face and flexures

Question 9

Corticosteroids MODERATE

Answer 9

Betamethasone valerate 0.02-0.05%, methylprednisolone aceponate 0.1%, triamcinolone acetonide 0.02%, clobetasone butyrate 0.05%) trunk, not for sensitive areas, try mild 1st, only use on sensitive areas if for a few days.

Question 10

Corticosteroids POTENT

Answer 10

Betamethasone dipropionate 0.05%, Betamethasone valerate 0.01%,
Mometasone furoate 0.1%,
Triamcinolone acetonide 0.1%
elbos, knees, palms, soles.

Question 11

Corticosteroids VERY POTENT

Answer 11

Betamethasone dipropionate 0.05% in optimised vehicle.

Question 12

Corticosteroid Adverse Effects

Answer 12

Skin atrophy due to loss of collagen. Promote underlying infection. Telangiectasia (prominent BV development). Dose dependant, increase risk with increase potency.

Question 13

Corticosteroid counselling

Answer 13

Used on all areas of inflammation until cleared.
Once daily application for potent.
Use until cleared up usually 7-14 days.
Remission maintained with emollients.
Use when there is a flare up.

Question 14

Other management

Answer 14

Antihistamines- sedating best to reduce itch.
Cyclosporin
UV therapy
Benzodiazepines.

Question 15

Refer?

Answer 15

Secondary infection
Warts/molluscum present
Herpes Simplex present
Not responding to treatment in a few weeks.