Atopic dermatitis

Question 1

What is filaggrin and how is it related to atopic dermatitis?

Answer 1

Filaggrin is a filament-associated protein that binds to keratin fibers in epithelial cells. Mutations in fillagrin genes is associated with transdermal water loss and atopic dermatitis.

Question 2

What are the main types of skin?

Answer 2

Dry (Atopic).
Fatty (Seborrhoic).
Mixed.

Question 3

What is characterstic of atopic skin?

Answer 3

Small sebaceous glands
Small pores
Little sebaceous matter
Blood vessels tend to contract.
Pale skin

Question 4

What is characteristic of seborrhoic skin?

Answer 4

Large sebaceous glands
Large pores
Fatty, gleary skin
Blood vessels dilate
Red skin

Question 5

What is “the atopic march”?

Answer 5

0-6 months: Atopic dermatitis.
6-12 months: Food Allergy. Viral induced asthma.
School age: Airway allergies. Exercise induced asthma.

Question 6

How many percent of children with atopic dermatitis recover by the time they’re 20 years?

Answer 6

90 %.

Question 7

What are typical locations with atopic dermatitis in children?

Answer 7

Inside of elbows and knees, wrist of hands, ankles and areas around ears and eyes.

Question 8

True or false: In children older than 3 years allergy is a more common cause of atopic dermatitis than in younger children.

Answer 8

False. Allergy is in general not the most common trigger for atopic dermatitis. 1/3 of 0-3 year old children exacerbate due to allergy. However, allergy is less important > 3 years of age.

Question 9

What are four important clinical features of atopic dermatitis?

Answer 9

Dry skin.
Itching.
Inflammation.
Infection.

Question 10

How is atopic dermatitis treated?

Answer 10

Dry skin: Moisturizing cream. Wet wrap. Oil baths.

Itching: Antihistamines. Avoid triggers such as heat and sweat, food irritants and/or allergens. Cut nail and use if necessary gloves during nighttime.

Inflammation: Topical corticosteroids. UV-treatment.

Infection: Topical treatment such as good hygiene, potassium permanganate bath, or corticosteroide cream with added antiseptics/antibiotics. Systemic antibiotics.

Question 11

Name some common triggers of itching.

Answer 11

Heat/sweat.
Climate.
Histamine releasing foods, e.g. strawberries, tomatoes, citrus fruits, cinnamon, etc.
Allergens, e.g. foods (like peanuts) or inhalation (like pollen).
Infections.

Question 12

What is meant by “stepping down” topical steroids?

Answer 12

After some days of topical steroids atopic dermatitis will recover. However, the inflammation is still active in dermis. If medication stops, a relapse will often occur. Instead of stopping, step down: Twice daily > once daily > three times pr week > twice weekly. An then stop when atopic dermatitis is in a good phase.

Question 13

What are signs of infection in atopic dermatitis?

Answer 13

Rubor / Redness.
Sticky and wet appearance. 
Yellowish crusts.
Spread to other location on the body.
Fever (in the worst cases).