Atopic Dermatitis Flashcards
MC chronic relapsing skin disease seen in infancy and childhood
Atopic dermatitis
Atopic dermatitis (AD) is aka
Atopic eczema
What is the “atopic march”
Development of AR and/or asthma later in childhood in children with AD
Cell population responsible for exaggerated immune response seen in patients with AD
T cells
Acute vs chronic AD lesion: Spongiosis or marked intercellular edema of the epidermis
Acute
Acute vs chronic AD lesion: Hyperplastic epidermis with hyperkeratosis and minimal spongiosis
Chronic
2 forms of AD
1) Atopic eczema 2) Nonatopic eczema
Form of AD associated with IgE-mediated sensitization (70-80%)
Atopic eczema
Form of AD not associated with IgE-mediated sensitisation (20-30%)
Non-atopic eczema
Hallmark of AD
Severely dry skin
A component of the cytoskeleton, the breakdown products of which are critical to skin barrier function
Filaggrin
Genetic mutations in the filaggrin gene have been identified on ___% of severe AD patients
50%
Cardinal features of AD (2)
1) Intense pruritus, especially at night 2) Cutaneous reactivity
Fibrotic papules characteristic of chronic AD
Prurigo nodularis
AD, infants/younger vs older children: More acute
Infants/younger children
AD, infants/younger vs older children: Lichenification
Older children
AD, infants/younger vs older children: Extensor surfaces of extremities
Infants/younger children
AD, infants/younger vs older children: Face and scalp
Infants/younger children
AD, infants/younger vs older children: Flexural folds of extremities
Older children
T/F AD in infants/younger children is characterized by sparing of diaper area
T
Major clinical features of AD (4)
1) Pruritus 2) Facial and extensor edema in infants and children/Flexural eczema in adolescents 3) Chronic or relapsing dermatitis 4) Personal or family history of atopic disease
Adolescents who present with an eczematous dermatitis but no history of childhood eczema, respiratory allergy, or atopic family history may have what disease entity
Allergic contact dermatitis
Cornerstone of anti-inflammatory treatment for acute exacerbations of AD
Topical corticosteroids
Co-morbid condition in approximately 40% of infants and young children with moderate to severe AD
Food allergy
Organism found in >90% of AD skin leasions
S. aureus
Most serious viral infection associated with AD
Kaposi varicelliform eruption or eczema herpeticum caused by HSV
Mainstay for prevention of flares as well as for long term treatment of AD
Identification and elimination of triggering factors
Criteria for the diagnosis of AD
Evidence of itchy skin (or parental report of scratching or rubbing) PLUS 3 or more of the ff: 1) History of skin crease involvement 2) History of asthma or allergic rhinitis (or history of atopic disease in a first-degree relative if child is less than 4y/o) 3) History of generally dry skin in the past year 4) Onset in a child less than 2y/o 5) Visible flexural dermatitis (including dermatitis affecting cheeks, forehead, and outer aspects of limbs in children less than 4y/o
5 criteria for diagnosis of AD are not used if the child is how old
Less than 4 years of age
