Atopic Dermatitis (Atopic Eczema)

Figure 1

Figure 2

Chronic inflammatory dermatosis affecting 10%—20% of children (esp. infants and young children)

Etiology: Cutaneous immune dysfunction; IgE-mediated; genetics. Strong association with personal and family history of atopy (eczema, asthma, hay fever).

History: Pruritus is a hallmark ("the itch that rashes"). Aggravating factors: sweating, contact sensitivity, secondary infection, wool, food allergy, stress/anxiety.

Physical:

• Acute: Erythematous, excoriated, scaling patches and plaques; more lichenification in chronic forms
• Distribution:
  • Infant: Cheeks, forehead, scalp, extensor surfaces of extremities.
  • Child: Flexural surfaces—antecubital and popliteal fossae, wrists, ankles.
  • Adults: Hands.
• Lesions can be secondarily infected with staphylococcal organisms: impetigo.

DDx: Contact dermatitis, psoriasis, seborrheic dermatitis.

Investigations: Allergy or RAST testing of little value.

See Topic(s):

• Atopic Dermatitis U.K. Working Party Criteria (1994)