Pruritus is most common symptom along with erythematous scaly lesions Definition Chronic pruritic inflammatory skin disease that occurs most frequently in children but also affects adults ID: 1038412
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1. Related to food and environmental allergies, asthma, and allergic rhinitisPruritus is most common symptom, along with erythematous, scaly lesionsDefinition:Chronic, pruritic, inflammatory skin disease that occurs most frequently in children but also affects adultsCharacterized by scaly, pruritic, erythematous lesion on flexural areasEtiologiesMultifactorial: genetic, immunologic and environmental factors that disrupt the epidermisTwo major risk factors are family history and mutations in filaggrin gene Criteria for diagnosis (see AAD diagnostic criteria)Essential features: chronic or relapsing history, eczema, pruritus, typical morphology and age-specific patternsImportant features: atopy, early onset, IgE reactivity, xerosis.Clinic based workupClinical diagnosis, no definitive lab test. Clinical tools to aid diagnosisScoring Atopic Dermatitis index (http://scorad.corti.li) VisualDX for differentials Atopic dermatitis (1)11/22/20, Marce ColomFrazier W, Bhardwaj N. Atopic Dermatitis: Diagnosis and Treatment. Am Fam Physician. 2020;101(10):590–8.
2. Infection by S. aureus and beta-hemolytic strep is most common complication. Prophylaxis NOT recommendedTesting for food or environmental allergies is NOT recommendedNo difference between OTC and Rx emollientsMedical managementMaintenance treatment: BID application of emollient and once-daily bathing in lukewarm water 5-10 min with soap-free cleanserFlare-up:Mild: maintenace + BID topical low-med potency steroidModerate: maintenance + BID topical med-high potency steroid + BID topical calcineurin inhibitor (TCI) +/- crisaborole +/- twice weekly dilute bleach baths +/- wet wrap therapy Severe: maintenance + BID topical high potency steroid + BID topical calcineurin inhibitor +/- twice weekly dilute bleach baths +/- wet wrap therapy + consider referral Other interventions and counselingDevelop an action plan for flare ups (see Wiki)Apply emollients (ointment preferred) within 3 min of bathingBleach bath: ½ cup of 6% bleach to 40 gallons of waterFollow up/ disease monitoring If flare up reassess at 2-4 weeks Monitor adherence and assess need for maintenance steroids or TCIWhen to consider specialist referral:Candidates for immunotherapy or immunosuppressive therapy, poor disease control, severe or recurrent infections, psychosocial problems 2/2 dermatitis, uncertain diagnosis, uncontrolled facial AD Atopic dermatitis (2)