Atopic dermatitis is actually often
referred to as "the itch
that rashes," rather than
the rash that itches,
because oftentimes, patients
report they feel itchy
even before the lesions have occurred. And
then once they start scratching,
then they start to have this erythema,
there's dry skin,
it's severely pruritic. And over time,
these erythematous papules
and vesicles start to arrive, perhaps with
even some exudates and crusting.
And over time, you'll get these dry,
scaly, excoriated plaques
with progressive lichenification. Eventually,
we'll have lesions called
lichen simplex Chronicus, which is LSC,
which is essentially just this leathery
skin from all this chronic itching
over a long period of time. I mentioned
those classic aspects
of where you should look for it. And in
adults, it may be more localized
and again, lichenified, this lichen simplex
Chronicus that I mentioned.
So, looking back at our case, I think we
can safely say that our patient has
a diagnosis of atopic dermatitis.
We're going to treat it by avoiding any
triggers, and again, you can do some
skin prick testing to try and figure
out exactly what the
nvironmental triggers are. It's really
important to educate
patients about preserving moisture.
That means avoiding taking hot
showers, don't scrub the moisture off your
skin with a towel after getting
out of the shower.
And you can use some topical
emollients, like petroleum jelly
or Eucerin cream, those kinds of
things to keep the skin moist.
Oral anti-histamines are used
for pruritus as tolerated.
We certainly can use topical inflammatories,
whether it's steroids
or some of the steroid-sparing agents
like the calcineurin inhibitors,
tacrolimus, pimecrolimus. And under severe
instances, we can move on
to UV light phototherapy.
We can use systemic steroids. That
would really be a desperate
sort of measure, and cyclosporine
will be somewhat less toxic.
So, key points for atopic
dermatitis. It's chronic,
relapsing, intensely pruritic, immune-
mediated skin disease
that tends to get better over
the span of a child's life.
Predilection for the antecubital,
the popliteal fossae,
the volar wrists, the ankles, the
hands. It's characterized
by dry, erythematous papules and vesicles.
You're going to look for lichenification,
especially as you get older,
and excoriations from all that scratching.
Keep the skin moist, avoid those allergens,
and if needed, use topical
glucocorticoids and calcineurin inhibitors.