Atopic Dermatitis occurs when environmental exposures trigger immunologic, usually allergic (IgE-mediated), reactions in genetically susceptible people
Common environmental triggers include foods (eg, milk, eggs, soy, wheat, peanuts, fish), airborne allergens (eg, dust mites, molds, dander
Staphylococcus aureus colonization on skin due to deficiencies in endogenous antimicrobial peptides Atopic Dermatitis is common within families, suggesting a genetic component
Symptoms and Signs
Atopic Dermatitis usually appears in infancy, typically by 3 months
In the acute phase, lasting 1 to 2 months, red, weeping, crusted lesions appear on the face and spread to the neck, scalp, extremities, and abdomen
In the chronic phase, scratching and rubbing create skin lesions (typically erythematous macules and papules that lichenify with continued scratching)
Lesions typically appear in antecubital and popliteal fossae and on the eyelids, neck, and wrists Secondary bacterial infections and regional lymphadenitis are common
Allergic precipitants of atopic Dermatitis can be identified with skin patch or prick test and/or measurement of allergen-specific IgE levels.
Atopic Dermatitis in children often improves by 5 yr of age, although exacerbations are common throughout adolescence and into adulthood. Girls and patients with severe disease, early age of onset, family history, and associated rhinitis or asthma are more likely to have prolonged disease
- Skin care involves moisturizing
- Bathing and hand washing should be infrequent and use lukewarm (not hot) water; soap use should be minimized on dermatitic areas because it may be drying and irritating
- Body oils or emollients such as white petrolatum, vegetable oil, or hydrophilic petrolatum (unless the patient is allergic to lanolin) applied immediately after bathing may help
- Fingernails should be cut short to minimize excoriations and secondary infections
Avoidance of precipitating factors
Household antigens can be controlled by using synthetic fiber pillows and impermeable mattress covers; washing bedding with hot water; removing upholstered furniture, soft toys, carpets, and pets
Antibiotics both topical Mupirocin and Fusidic acid
Corticosteroids are the mainstay of therapy.
Creams or ointments applied bid are effective for most patients with mild or moderate disease.
Emollients are applied between corticosteroid applications and can be mixed with them to decrease the corticosteroid
amount required to cover an area.
Light therapy is helpful for extensive atopic Dermatitis
Natural sun exposure ameliorates disease in many patients
Alternatively, therapy with ultraviolet A (UVA) or B (UVB) may be used
UVA therapy with psoralen (PUVA—see Psoriasis and Scaling Diseases: Light therapy) is reserved for extensive, refractory atopic Dermatitis