Skin Ailments—Dermatitis
Dermatitis—inflammation of the skin
Atopic dermatitis (eczema)
General—inflammation of the skin typically in those with a family history of atopy
Clinical
Acute flares—erythema, pruritus, with or without serous discharge → encrustation, scale
Chronic—lichenification, fibrotic and pigmentary changes; xerosis (dry skin)
Etiology—evidence suggests genetic susceptibility, leads to immune dysregulation (↑ immunoglobulin E [IgE])
Epidemiology—affects approximately 10% of children and approximately 1% of adults
Treatment
Hygiene—bathing and use of moisturizers
Bathe with warm water for 5 to 10 minutes once each day.
Use soap only if needed (mild cleansers = Dove, Cetaphil).
After bathing (and before skin is fully dry) apply moisturizer.
Consider application of Eucerin, Aquaphor, mineral oil, or baby oil.
Apply ointments (most effective) ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b033aa4395443a4b97e7821ad0a934bbb}/ID(AB1-M10)”>> creams ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b033aa4395443a4b97e7821ad0a934bbb}/ID(AB1-M10)”>> lotions (least effective).
Maintaining skin hydration is critical.
Avoid low humidity environments; avoid rapid temperature change.
Sedating antihistamines (decrease pruritus refractory to moisturizers)
Tricyclic antidepressants (their antihistaminic properties decrease pruritus)
Topical corticosteroids (mainstay of therapy)
Oral corticosteroids (for treatment-resistant disease)
Prednisone 40 to 60 mg daily × 4 days and taper to nil over 2 to 4 weeks
Calcineurin inhibitors (for short-term use because long-term risks are less well known)
(Mild-moderate eczema) pimecrolimus topical (Elidel)—apply BID.
(Moderate-severe eczema) tacrolimus topical (Protopic)—apply BID.
Other
Cyclosporine, methotrexate, azathioprine, mycophenolate mofetil, or ultraviolet (UV) phototherapy
Complications
Secondary infections with staphylococcal (S. aureus) and streptococcal species
Treatment
Eczema herpeticum (herpes simplex virus [HSV] infection)
General—vesicles, crusts, and so on complicating atopic dermatitis
Treatment
Contact dermatitis
General—inflammation of the skin secondary to direct interaction of skin with an irritant
Clinical—eczematous (erythema, pruritus, with or without serous discharge → encrustation, scale)
Varying degrees of edema, vesiculation, and lichenification (hardening)Related posts:
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