1. Atopic Dermatitis

2. Dermatitis Pattern of cutaneous inflammation – Acute: erythema, vesicles, pruritis – Chronic: dryness, scaling, lichenification, fissuring, pruritus E.g. seborrheic, atopic, contact

3. Basics Chronic, pruritic, inflammatory skin disease with a wide range of severity Affects up to 20% of children and 1-3% of adults Atopic triad Primary symptom: pruritus (itch) – Hence, AD is often called “the itch that rashes” – Periods of remission & exacerbation

4. Note Eczema=/= Atopic dermatitis Atopic dermatitis is a specific type of eczematous dermatitis

5. Clinical Findings Erythematous papules, which coalesce to form erythematous plaques that may display weeping, crusting, or scale Distribution by age: – Infants: cheeks, forehead, scalp, extensors – Older children: flexors of the neck, elbows, wrist, and ankles – Adults: flexors of the hands, wrists, ankles, feet, and face (forehead, around the eyes)

6. Infants & toddlers

7. More examples

8. Older children & adolescents

9. Pathogenesis Not clearly understood Probably multifactorial Factors thought to play a role: – Genetics – Skin barrier dysfunction – Impaired immune response – Environment

10. Treatment Avoidance of triggers and irritants Gentle skin care Combination of short term treatment for flares + longer-term treatment for symptoms between flares

11. 4-pronged approach -Moisturizer -Anti-inflammatory -Topical steroids -Topical calcineurin inhibitors -Anti-pruritus -antihistamines -Antibacterial

12. Notes Safe for short intervals with intermittent breaks Increase potency to control inflammation, then stop for break Avoid potent steroids in areas of the face, folds, or occluded areas (under diaper)

13. Take Home Points AD is a chronic, pruritic, inflammatory skin disease Distribution varies by age Pathogenesis is multifactorial Treatment: moisturizer, anti-inflammatory, antipruritic, antibacterial

14. Contact Dermatitis

15. Basics Skin condition created by a reaction to an externally applied substance Two types of CD: – Allergic CD – Irritant CD

16. ACD Occurs when contact with a particular substance-> delayed hypersensitivity reaction Which type? Sensitization process: 10 -14 days Common causes: – Poison ivy, fragrances, formaldehyde, preservatives, nickel, rubber, topical antibx

17. ACD: Clinical Findings Pruritus (itching) Eczematous, scaly edematous plaques with vesicles in areas of exposure

18. Rhus Dermatitis

19. Medication allergy

20. Nickel Dermatitis

21. Latex allergy

22. History Important to take comprehensive hx Onset Location Temporal associations Daily skin care routine, topical products, occupation/hobbies, regular and occasional exposures (lawn care products, animal shampoos)

23. Treatment Avoidance of allergens – Patch testing Acute – Mild to moderate: topical steroids of medium to strong potenncy – Short course of systemic steroids for acute flares – Wet dressings for extensive oozing/crusting Chronic or > 10% BSA – Refer to dermatology

24. Patch testing

25. ICD Inflammatory reaction from exposure to substance that can cause an eruption in most people who come in contact with it No previous exposure necessary May occur from single application, but most commonly from repeated application

26. ICD: basics Accounts for 80% of all contact dermatitis Often occupation-related Remains at site of contact and resolves in a few days after exposure (ACD: 1-3 wks)

27. Factors at play Multifactorial – Exogenous (irritant, environmental) – Endogenous (host)

28. ICD: Clinical Findings Erythema, chapped skin, dryness and fissuring Pruritus Pain when erosions and fissures are present Severe cases: edema, exudate, tenderness

29. Examples

30. Treatment Avoidance of irritant – Patient education – Personal protective equipment – Less irritating hygiene products Topical steroid-> reduce inflammation Emollients-> improve barrier repair Patch testing to r/o ACD

31. Take Home Points Contact dermatitis: ACD and ICD ACD= when contact elicits delayed hypersensitivity reaction ICD= exposure to substance that can cause an eruption in most people Identification and avoidance