Atopic Dermatitis ■ An acute, - PowerPoint Presentation

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Atopic Dermatitis

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■ An acute,

subacute

, or chronic relapsing

skin disorder.

■

Very common in infancy.

■ Prevalence peak of 15–20% in early childhood

.

■ Dry

skin

and pruritus

;

lichenification

and to

further itching

and

scratching

■

Diagnosis is based on clinical findings

.

■ Family history of

AD,

■

Associated with skin barrier dysfunction,

IgE

reactivity.

■ Genetic basis influenced by environmental

factors.

Synonyms

:

IgE

dermatitis, “eczema,” atopic eczema.

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Hanifin

and

rajka

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Clinical features

Divide AD based on:

1- Acute , subacute , chronic

2- infantile, childhood, adult/adolescent ,senile AD

3- mild, moderate, sever

4- regional variants

In

any stage of AD, severe cases can progress to generalized

exfoliative

erythroderma

.

All type can leave

hyper- PIH, in severe cases can be hypo-

PIH or

depigmention

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Chronic (Adolescence/Adults): Thickened plaques with lichenification, scale,

prurigo

nodules

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Gender

differences

: Influence

of sex hormones?

(Chen et al, Allergy 2010

)

In

childhood

more common in boys, in adulthood women are more often affected

Mast

cells carry androgen receptors; androgens have inhibitory effect

Estrogens

increase

IgE

production from B cells

Testosterone

substitution cures eczema in a patient with hypogonadism

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Special Forms of AD

Exfoliative

Dermatitis

Erythroderma

in

patients with extensive skin involvement.

Generalized

redness, scaling,

weeping, crusting

, lymphadenopathy, fever, and

systemic toxicity.

Exfoliative

Dermatitis

Erythroderma

in

patients with extensive skin

involvement. Generalized

redness,

scaling, weeping, crusting

, lymphadenopathy, fever, and

systemic toxicity

.

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Atopic stigmata

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Sign?

ddx

?

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Other type?

Where do u see it?

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complications

1- infection

eg

s.aureus

, eczema

herpticum

, MC

2-ocular complication

3

- sleep disturbance

4-impair function at school

5

- depression, ADHD (

cme

jaad

2014)

6- Obesity and cancer inconsistent result , some suggest higher rate of lymphoma

(

cme

jaad

2014)

7- PIH , chronic dry skin

8

-short , poor growth especially in sever skin

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Treatment

Management of

AD includes the following components

:

avoidance of trigger factors, including irritants, relevant

allergens and

microbial agents

skin care that aims to compensate for the genetically

determined impaired

epidermal barrier function

anti-inflammatory

therapy to control subclinical inflammation

as well

as overt flares

in selected cases, adjunctive or complementary modalities.

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Management adapted

to the severity of the disease

.

M

ild

cases

can typically be controlled by continuous use of

emollients and

intermittent use of a low-potency topical corticosteroid

for flares

M

oderate

AD

may also require proactive maintenance

with anti-inflammatory agents.

Severe

and refractory cases

, the use

of phototherapy

and systemic drugs may be necessary to control

the disease

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