Atopic Dermatitis

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Atopic Dermatitis (AD)/Eczema

Chronic dermatitis or eczema pruritic condition. Frequently associated with allergies, hay fever, sinusitis or asthma – IgE levels are high (95% of those with atopic dermatitis have asthma). Strong hereditary/family influence. Involves some disturbance to immune system (in those genetically predisposed) - especially imbalance of cytokines. Usually have high serum levels of IgE antibodies (indicates an abnormal response to a trigger) and abnormal lipid concentration in the skin. Occurs in up to 5-10% of infants – most have remission by age 15. Incidence is assumed to be increasing.

Clinical features:
Characterised variably by patches of pruritis, moist erythematous weeping skin in acute stage and dryness, scaling, and lichenification in the chronic stage. Begins on face – later involves flexor surfaces of the extremities – often improves by ages 3 to 4. In adulthood, may reappear on hands and feet. Itch cycle can induce lichenification.
Skin can be dry. Can also get hyperlinear palm and sole creases that worsen with lubrication.

Trigger factors – house dust mite (most common), foods (eg peanuts, eggs, milk, wheat), contact allergens

Treatment – parental education; avoidance of itching; treat inflammation (topical steroids are first line drug for flare up); dry skin care (brief bathing; hydration with bland emollients); control exacerbating factors; reduce exposure to antigens; immunomodulatory drugs if severe (eg cyclosporine).

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