Ver el código de «Atopic dermatitis»

==Background==
{{Skin anatomy background images}}
*Also known as atopic eczema
*A chronic type of inflammatory skin disease affecting many children and adults
*Occasionally accompanied by [[asthma]] and/or hay fever. Patients develop a cutaneous hyperreactivity to environmental triggers. 
*Cause is not known, but believed to be due to an interaction between susceptibility genes, the environment, defective skin barrier function, and immunologic responses.

{{Dermatitis types}}

==Clinical Features==
[[File:Atopic dermatitits.jpg|thumb|]]
[[File:Atopy2010.jpg|thumb|Atopic dermatitis of the inside crease of the elbow.]]
*Atopic personal or family history, worse in winter, dry weather
*Erythema, crusts, fissures, [[pruritus]], excoriations, lichenification

===Infantile===
*blisters, crusts, exfoliations
*Face, scalp, trunk, extensor surfaces, sparing of diaper area
*1st few months of life, resolving by age 2
*Differentiate from [[impetigo]] (which may occur alongside)

===Childhood===
*~4-12 years old
*Wrists, ankles, antecubital and popliteal fossae

===Adults===
*>12 years old
*Dryness, thickening in flexor surfaces including antecubital and popliteal fossae, neck, hands<ref>Leung DYM, Sicherer SH. Atopic Dermatitis (Atopic Eczema). In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020:(Ch) 170.</ref>

==Differential Diagnosis==
{{Neonatal rashes DDX}}

==Evaluation==
*Clinical diagnosis
**Dry skin, erythematous papular lesions
**Face most commonly involved; nose and diaper areas spared

{{Neonatal atopic dermatitis vs seborrhoeic dermatitis}}

==Management==
*Identify and eliminate triggers:
**Alcohol based products
**Fragrances and astringents
**Excessive bathing
**Allergens 
*Reduce drying of skin
**Avoid lotions (high water and low oil content)
*Liberal application of emollients (vaseline) immediately after bath (<5 min, skin should be pat dry instead of rubbing) <ref>Fang J. Dermatology. In: The Harriet Lane Handbook. 20th ed. Philadelphia, PA: Elsevier; 2015</ref>
**Alternatives include petroleum jelly and Aquaphor
**If using steroids, apply emollients on top of steroids
*[[Topical steroids]]
**7 days of low or medium potency steroid ointments either daily or BID
***[[Triamcinolone]], [[hydrocortisone]], or [[betamethasone]]
**Severe flares require high potency steroids followed by a taper
***[[Topical steroid potency]] for additional options
*Avoid fluoridinated steroids to thin skin areas such as face, groin, or axilla
*Consider [[doxepin]] for recalcitrant pruritus<ref>Hercogova J. Topical anti-itch therapy. Dermatol Ther 18(4):341-3 (2005 Jul-Aug).</ref><ref>Drake L, Cohen L, Gillies R, et al. Pharmakinetics of doxepin in subjects with pruritic atopic dermatitis. J Am Acad Dermatol 41(2):209-14 (1999 Aug).</ref>
**25-50mg PO nightly
**Or topical doxepin cream 5% QID

==Disposition==
*Outpatient

==Complications==
*Secondary [[Skin and soft tissue infections|bacterial infection]]
*[[Eczema herpeticum]], widespread HSV infection
*[[Dyshidrotic eczema]]

==See Also==
*[[Neonatal Rashes]]
*[[General approach to rashes]]
*[[Pediatric rashes]]

==External Links==
https://pedemmorsels.com/atopic-dermatitis/

==References==
<references/>

[[Category:Dermatology]]
[[Category:Pediatrics]]