ATOPIC DERMATITIS

By: Dr Kambunga
Some pictures on dermatitis
 Impact of Atopic Dermatitis
prevalence -- 10-17% of all children*
mild in 85%
moderate to severe -- profound effect on QOL
intractable itching and sleep loss
soreness, scarring, dyspigmentation
social stigma
costs more than childhood diabetes
4% of adults with persistent disease
40-60% continue to experience disease intermittent exacerbations

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 Diagnosis of Atopic Dermatitis
Diagnostic Criteria
Pruritus
Eczema (from Greek - to boil, to erupt)
chronic & recurring
acute
chronic
subacute

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 Atopic Dermatitis
Clinical Presentation
6 skin findings of eczema
1. erythema
2. papules/edema
3. exudation - oozing and crusting
4. scaling
linear erosions from scratching

symmetric > asymmetric

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 ATOPIC DERMATITIS
Infantile Distribution
face - cheeks and chin
head light sign mid-facial sparing
extensor extremities, dorsal hands and feet
very rarely on palms or soles
can have widespread involvement
diaper area often spared
pruritus

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 ATOPIC DERMATITIS
Childhood-Adult Distribution
antecubital and popliteal fossae
posterior neck
presacral back, buttocks, flanks
eyelids
scalp
hands, feet palms and soles
may be severe and generalized
head light sign
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Complications of AD

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Eczema Herpeticum

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Eczema
Vaccinatum

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Impetigo

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Treatment Approach

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 ATOPIC DERMATITIS
5 Es to an Exceptional Eczema Experience

1. Education - level of success is directly related to how much

education patients and their families receive about AD*

2. Expectations
Endpoints
Clearance vs Maintenance phases of therapy
3. Encouragement
4. Enough medication campfire analogy
5. Early return visit (2 weeks)

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 Nice Not nice,
& Rough
Smooth & Yucky

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Pimecrolimus Treatment of Atopic Dermatitis

3 weeks

Baseline

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 Atopic Dermatitis Therapeutic Pyramid

Systemic Immunomodulators

UV Phototherapy
Allergy Testing/Avoidance
Habit Reversal
Antihistamines
Anti-Staph Antibiotics
Topical Calcineurin Inhibitors
Topical Steroids
Protective Skin Care & Trigger Avoidance
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