Here, we’ll take a look
at atopic dermatitis.
Now, this is extremely common,
and must be spoken of why,
because when you talk about atopic type
of issues, you’ve heard of asthma.
With asthma, majority of
your asthma is of what type?
Oh yeah, it’s atopic, isn’t it?
There is intrinsic as well
but you focus on atopic.
The point is this.
When you talk about atopy or atopic,
what does that mean to you?
You’re talking about a
patient in environment
that has been exposed
to certain allergens.
And obviously, in the U.S., we have pollen,
pollen, pollen, whatever it may be, huh?
When you’re exposed to that type
of allergen, there is every
possibility that you might then
elicit a type 1 hypersensitivity.
And therefore, you would have release
of histamine working on H1 receptors
bringing about bronchoconstriction
that gives you your atopic asthma.
In such patients, you might also have
development of atopic dermatitis.
Familial maybe, maybe unknown.
Associated with asthma.
Let me stop there and make sure that you’re
crystal clear about that association.
Oftentimes, as I
told you earlier,
if your patient is experiencing
there’s every possibility that atopic
dermatitis is also part of this.
Also, allergic type of rhinitis.
This is called your atopic triad;
asthma, rhinitis, and dermatitis.
this is your type 1 hypersensitivity
involvement of your helper type 2 T-cells.
incidence, especially in the U.S.
Most common in childhood, and growing out
of it is luckily what happens to the child.
So, if there is atopic asthma and there is
atopic dermatitis and rhinitis or whatnot,
then the patient, the child,
as he or she is growing up,
will no longer suffer from it.
That’s always good news.
What about the morphology?
Highly pruritic as you can examine,
highly pruritic as you examine.
And eczematous type of plaque as
you take a look at this closer,
and by that, we mean that the
lesion that you’re seeing here,
these plaques are eczematous, we
call this weeping type of plaques.
And it’s itchy, right, upon examination.
Further history, the
patient is going to say --
or the child is going
to itch, itch, itch.
And if it’s itchy enough, at some
point, my goodness gracious,
the plaque, that eczema is going
to then offer resistance,
or should I say adaptation,
and that type of adaptation we’ll
talk about is called lichenification.
So, it’s a story that
we’ll talk about.
At this point,
our topic is atopic dermatitis,
just discussed demographics,
highly pruritic and eczematous.
The location of plaque changes with
advancing age, and this is huge.
So, if you’re a child,
then think about your aunt
who’s squeezing you
in the cheeks.
“Oh, it’s been so long since I’ve
seen you my boy, or my girl.”
So, face and extensor
surfaces in infants.
Think about cheeks and such in a child.
The eczema that you
find in an adult,
you’re thinking about the flexural areas
in older children and some adults.
The location of your particular
eczema with atopic dermatitis,
which is extremely pruritic,
is going to change based on age.
That’s important for you
to take out of this.
With atopic dermatitis, associations are
common conditions we’ll talk about soon enough.
In Greek, we have ichthyosis,
and by that we mean ichthy-,
means fishy scaling of the skin.
Other association is keratosis pilaris.
Then another one called
Now, if you take a look at the morphology
here of the eczema that I’m showing you,
we have residual eczema on
the cheek of this patient,
and then obviously, the flexural
areas that you see here.
And these are your weeping
type of vesicles,
and keep in mind
that this is itchy.
Further morphology here, if you’d
take a look at atopic dermatitis,
would be more of your weeping vesicle
type of appearance in the flexural region,
Well, if that particular patient
or the parents of the child
in which the child is developing
atopic dermatitis/rhinitis and asthma,
the atopic triad,
then educate the parents,
or maybe the child to say,
“Okay. Well, maybe perhaps, you want
to try to avoid such environments
or be careful about exposure
to that particular antigen.”
gentle bathing, and
Remember, it’s itchy, itchy, itchy.
And if you keep itching this and you
do not apply any type of, let’s say,
ointment or emollient,
then at some point in time, that particular
plaque might then react or adapt
and then may become extremely --
well, I don’t want to
use the word scarred
because in medicine, we have to call
it lichenified or lichenification.
Topical steroids, and
for that itch because we’re dealing
with our type 1 hypersensitivity.
The differentials quickly:
What’s the difference?
exposure to allergens,
if that helps you, huh?
Most likely in the environment.
Hence, in the U.S.,
it’s a growing field.
So, those of you that wish to go into
allergy or you want to become an allergist,
your practice is
going to be filled,
because you have tons of patients that
are suffering from that atopic triad.
a differential will be contact.
What does that mean?
Usually revealed by history.
What kind of history?
Well, maybe there was unusual
pattern with sharp demarcation,
but the history here literally,
let’s say that you have
coins in your pocket
and you are “allergic” to
that nickel in the coin.
You’re wearing your jeans,
and the jeans are pressing the nickel in
the coins upon the skin, huh?
And therefore, it may result
in a type 4 hypersensitivity,
resulting in contact dermatitis.
Hopefully, that’s clear.
We’ll talk more.
Quickly, as soon as hear seborrheic
dermatitis, close your eyes.
On the face.
If it’s in adult, tell me
about the nasolabial fold.
Is there or is there not involvement of the
nasolabial fold in seborrheic dermatitis?
You’re going to tell me.
Yes, there is, very good.
When is it not?
Your malar rash seen with SLE.
Are we getting better at this?
If it’s an infant, where
would you find this?
Oh yeah, cradle cap.
Hopefully, if it’s
mild in an infant,
because of the flaking
of skin on the scalp,
With dermatitis, it’s more likely to
involve in the diaper area as well.
Keep that in mind, okay?
diaper dermatitis, limited
to the groin area,
dermatitis is unusual.
Groin area is unusual
in atopic dermatitis.
Often spares the body folds
where feces and urine does
not contact the skin.
We’ll talk about a condition
called mycosis fungoides.
Let’s just put it this way.
I am dissatisfied with the
name as should you be.
It has nothing to do with fungi, nothing.
It is a T-cell type of cancer.
It’s a cancer.
So, when the time
this is the first time that
I’m introducing this to you.
But mycosis fungoides has
nothing to do with fungi.
In fact, these are
cancerous, or should I say,
a T-cell type of cancer that
is then limited to the tissue.
You’ve heard of Sézary syndrome.
When the time is right, we’ll
talk about two conditions.
At this point, keep it as a
differential because of --
what are you going to find
with atopic dermatitis?
Eczema, it’s erythematous.
You might also find this
with mycosis fungoides.
Obviously, atopic dermatitis
is not at all cancer.
And on top of that, it’s uncommon
in children, mycosis fungoides.
Often involves the double protected
sites beneath the undergarments.
We’ll talk further about
that, double protected.
So in other words, something that you
feel is though will be protected
and would be then
immune to such changes.
Here in this cancer, seriously,
everything is susceptible to damage.