Atopic Dermatitis

Acute, subacute or chronic relapsing, endogenous eczema, characterized by dry skin pruritic, recurrent, symmetric dermatitic lesions.

Etiology is unclear.

Genetic predisposition is an important factor but the inheritance pattern has not been ascertained.

Immunological changes – elevated IgE levels, abnormalities of lymphocytes.

Clinical Features – In children, two distinct patterns of AD are seen.

1.Infantile pattern

2.Childhood pattern

Hanifin and Rajkar’s criteria for atopic dermatitis

Infantile pattern – Onset in infancy, after 3 months of age. The chief features are itchy, erythematous papulovesicles, seen on the face but may become generalized. The lesions clear by 18 months of age in 40% and evolves into the childhood pattern in the rest.

Childhood pattern – Dry lichenified and crusted plaques, seen mainly on antecubital and popliteal fossa, the neck and face. Most (70%) clear by 10 yr of age. Common complications include the occurrence of superimposed bacteria or viral (herpes simplex, molluscum contagiosum) and fungal infections. The diagnosis of atopic dermatitis is facilitated by diagnostic criteria.

Childhood pattern

Treatment – Educated

1.about the disease and its chronic course.

2. Breastfeeding decreases the chance of developing atopic dermatitis.

3. Avoid scratching, contact with irritants, like woolens and chemicals.

Mild soaps and cleansing lotions are used. Measures to reduce exposure to house dust mite, e.g. using barriers on pillows and mattresses, regular vacuuming of rooms may help. There is no contraindication to vaccination except in children specifically allergic to eggs, in whom influenza and yellow fever vaccines are avoided.

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