Atopic Dermatitis & Seborrheic Dermatitis

Question 1

Do a lesion description of atopic dermatitis

Answer 1

Lezyon:
i) Acute:
>Oozing and crusting over erythematous base.
>Staph. aureus ile enfekte olabilirler. Bu sebeple bal rengi krutlar görebiliriz (impetiginize olmuş atopik dermatit). Bu durumlarda kültür alıp, staf varsa tedavi etmeliyiz.

ii) Subacute: Erythematous scaly patch and plaques

iii) Chronic:
Lichenified plaques, characterized by thickening of the skin (skin lines are fairly visualized, result of chronic rubbing, itching of the skin)
>There is hyperkeratosis histologically, there is acanthosis which means the increased thickness of the epidermis so that is why we see these lichenified lesions.
>Lichenification: Shiny surface on the dorsal hands with prominent, conspicious skin marks

Question 2

Describe where the lesions are located + its associated clinical features of atopic dermatitis

Answer 2

Lezyon Lokalizasyonu:
>Küçük Çocuk: ekstensör
>Büyük Çocuk: flekör

Infants: Cheeks, trunk and extensor extremities

Young children:
Posterior neck
flexor extremities (antecubital-popliteal), wrists, ankles, hands

Older children and adults: Posterior neck,
flexor extremities,
hand involvement.
Chronic AD features, lichenification, prurigo nodularis, postinflammatory hypo/hyperpigmentation

Associated Clinical Features:
Pruritus
Xerosis
Keratosis pilaris
Ichthyosis vulgaris
Palmoplantar hyperlinearity
Pityriasis alba
Cheilitis
Prurigo nodularis

Question 3

What are diagnostic criteria for atopic dermatitis?

Answer 3

check notion

Question 4

Describe the treatment modalities of atopic dermatitis

Answer 4

First-Line:
>Eğitim: Cilt kuru kalmamalı. Wool, çok sıcak havalar, terleme gibi iritanlardan kaçınılmalı.
>Nemlendiriciler: cilt bariyerinin restorasyonu
>Topikal Kortikosteroid: hafif-orta vakalar için. Moderate-mild potent
>Akut (oozing, wet lezyonlar): wet dressing
>S. Aureus kolonizasyonu varsa: topikal ya da oral antibiyotik

Second-Line:
>Pimecrolimus ve Tacrolimus:
(1) Kortikosteroid-free
(2) 2 yaşın üstündekilere kullanılmalı
>Antimicrobials (superenfeksiyon, S. Aureus kolonizasyonu)
>Sedatif Antihistaminler: çok kaşıntılı olduğu için

Third-Line: Eğer konvansiyonel tedavilere rağmen devam ediyorsa
>NB-UVB
>Cyclosporine
>Methotrexate
>Sistemik kortikosteroid
>Mycophenolate mofetil
>Dupiluman (anti-IL4 biyolojik ajan)

Question 5

When do you use powder in atopic dermatitis?

Answer 5

in case of likenifikasyona

Question 6

Which mutation causes epidermal barrier dysfunction in atopic dermatitis?

Answer 6

filaggrin

Question 7

Describe the ddx of atopic dermatitis

Answer 7

Seborrheic dermatitis
Psoriasis
Contact dermatitis: well-demarcated eczematous plaques, usually localized to areas of contact

Question 8

Describe the differences of AD, Seborrheic Dermatitis, and Psoriasis in regards to the following features (onset, face, scalp, extremities, folds or groin, nails, shape, color, scale, and symptoms)

Answer 8

check notion

Question 9

Compare atopic dermatitis to Psoriasis

Answer 9

> Well-demarcated, persistent plaques with overlying scale
Involvement similar to SD
Scalp, diaper area
Nail involvement in psoriasis
Family history of psoriasis in 1/3

Question 10

Compare Atopic Dermatitis to Seborrheic Dermatitis

Answer 10

> Yellow, greasy scale most commonly on head, face, and neck region, Bipolar involvement (Head-Neck, Genital): SD
Not as pruritic as atopic dermatitis
AD usually spares diaper area
AD usually spares nasal tip (Yamomoto sign)