dermatologic disorders
Atopic Dermatitis (Eczema)
Symptoms and Signs of Atopic Dermatitis
Atopic dermatitis usually appears in infancy, as early as 3 months of age. In theacute phase,lesions are intensely pruritic, red, thickened, scaly patches or plaques that may become eroded due to scratching. In thechronic phase,scratching and rubbing create skin lesions that appear dry and lichenified. Distribution of lesionsis age specific. In infants, lesions characteristically occur on the face, scalp, neck, eyelids, and extensor surfaces of the extremities. In older children and adults, lesions occur on flexural surfaces such as the neck and the antecubital and popliteal fossae. Intense Itching is a key feature. Itch often precedes lesions and worsens with dry air, sweating, local irritation, wool garments, and emotional stress. Common environmental triggers of symptoms include Excessive bathing or washing Harsh soaps Staphylococcus aureusskin colonization Sweating Rough fabrics and wool This photo shows erythematous crusted plaques on the popliteal fossae and legs. © Springer Science+Business Media Atopic dermatitis usually develops in infancy. In the acute phase, lesions appear on the face and then spread to the neck, scalp, and extremities. Image provided by Thomas Habif, MD. In the chronic phase of atopic dermatitis, lesions are dry and lichenified. Image provided by Thomas Habif, MD. Lichenification is thickening of the skin with accentuation of normal skin markings; it is a result of chronic scratching or rubbing, which in this patient occurred during the chronic phase of atopic dermatitis. Image provided by Thomas Habif, MD. Secondary bacterial infections (superinfections), especially staphylococcal and streptococcal infections (eg, impetigo, Cellulitis ) are common. Erythroderma (erythema that covers more than 70% of the body surface area) is rare but can result when atopic dermatitis is severe. is an infection with herpes simplex virus (HSV) of the skin that is more diffuse and widespread than those in nonatopic patients. Eczema herpeticum is commonly the primary HSV infection, but can also result from recurrent infection, in patients with atopic dermatitis. It manifests as grouped vesicles in areas of active or recent dermatitis, although normal skin can be involved. High fever and adenopathy may develop after several days. Occasionally, this infection can become systemic, which may be fatal. Sometimes the eye is involved, causing a painful corneal lesion. Live vaccinia virus vaccine complications is a similar complication due to smallpox vaccination, in which the vaccinia virus disseminates and may become life-threatening. Atopic patients should therefore not receive smallpox vaccinations. Atopic patients are also prone to other viral skin infections (eg, Herpes Simplex Virus (HSV) Infections , Patients with atopic dermatitis also have a higher risk of allergic contact reactions. For example, contact allergies to nickel, the most common contact allergen, are twice as common as in nonatopic patients. Frequent use of topical products exposes patients to many potential allergens, and allergic contact dermatitis caused by these products may complicate the treatment of atopic dermatitis. 