Criteria for the Diagnosis of Atopic Dermatitis MAJOR

Criteria for the Diagnosis of Atopic Dermatitis � MAJOR ü ü FEATURES : Pruritus (the most important) Facial and extensor eczema in infants and children ü Flexural eczema in adolescents ü Chronic or relapsing dermatitis ü Personal or family history of atopic disease

Epidemiology � >10% � 90% of infants onset before age 5 � Atopic march: >50% of patient develop asthma or other allergy

Etiology � Genetics(fillaggrine mutation), Environment: Skin barrier damage ü Ig. E to Staphylococcus aureus toxins , Superantigen stimulation causes Treg lose suppressive activity ü A decrease or absence of antimicrobial peptides ü � Acute: IL-4, IL-13 � Chronic: IL-5, IL-12, IFN-γ

Type of Eczema

Presentation 1. Older children and adults have lichenification of flexor surfaces including: � � Hands Feet Face Antecubital and popliteal fossa 2. Infants have involvement of: � � � Extensors Neck Trunk Face Spares nasolabial skin fold

Laboratory � Skin biopsy can be useful in patients who do not respond well to corticosteroids � Patch testing is useful in patients with suspected contact allergen such as nickel or cosmetics � SPT for identifying aeroallergen triggers such as: ü Dust mites ü Animal dander ü Weeds ü Molds

Patch tests

Complications � Staphylococcus aureus � herpes. Kaposi(varicelliform eruption or eczema herpeticum ) � molluscum contagiosum, papillomavirus (warts) � Malassezia furfur, and Pityrosporum ovale. � Eczema Vaccinatum (smallpox vaccination) � Anterior cataracts are associated with Atopic keratoconjunctivitis. � Posterior cataracts are associated with Prednisone

Triggers of AD � Food (milk, egg, soy, wheat, fish, peanuts, and tree nuts) � Aeroallergens( Weeds, Molds) � Dust mites, Animal dander, Autoantigens � Microbial Agents and Toxins

Differential Diagnosis

Treatment � Cutaneous hydration and emollients � Topical corticosteroids: � Topical calcineurin inhibitors � Avoidance of triggers of AD � Antihistamines � Novel to control itching. treatments include Vitamin D � Immunotherapy for aeroallergen