The hallmark of atopic dermatitis (AD) is itching, which can be severe. AD is characterized by redness, scaling, and lichenification. In adults, it most commonly occurs in the antecubital and popliteal fossae and on the nape of the neck. Simply because there's no accurate main lesion, patients with AD frequently present solely with itching or so-called sensitive skin. As the skin is scratched or rubbed to obtain relief, it may show excoriations, vesiculation, and crusting. Secondary bacterial infection of the skin is typical.
Presentation of AD is variable, depending on the age of the patient. In infants and kids, the redness and scaling may be on the extensor surfaces, face, or trunk. Infantile AD might be short-lived or may be a prodrome to lifelong dermatitis. As the child grows older, the conventional flexor areas become involved.
Patients with AD often have hyperlinear palms and infraorbital creases, so-called Dennie Morgan folds. Rubbing of the lips creates cracking and surrounding erythema, known as the furrowed mouth syndrome. In older patients or during times of quiescence, the only manifestations of AD might be dryness and scaling erythema crackle. Linked conditions include pityriasis alba, in which you will find irregular patches of scaling and hypopigmentation, and keratosis pilaris (KP), the nearly physiologic hyperkeratotic accentuation of hair follicles on the lateral and posterior upper arms and on the anterior thighs.
KP presents as firm red or skin-colored papules, giving a sandpaper feel to the area. African-American patients may also have perifollicular accentuation like goose flesh.
Seborrheic dermatitis is usually limited to the scalp, glabella, and perinasal region. Get in touch with dermatitis, particularly when it's on the hands, can mimic AD. The history helps in achieving a diagnosis. Neurodermatitis has a similar morphology and sometimes more varied distribution, but the distinguishing feature is the lack of atopic history asthma, allergic rhinitis, or eczema in the patient or in a relative. Redness and scaling on the feet might recommend tinea pedis; however, children rarely have a dermatophyte infection, and the lack of interdigital involvement guidelines out a fungal infection.
Even though AD might outcome in eosinophilia or elevated immunoglobulin E (IgE) levels, the diagnosis is produced by observation and the personal or family history of atopy. Hyperlinear palms and Dennie Morgan fold are helpful clues. White dermatographism, in which stroking the skin gives a raised white line, is common.
The most essential aspect of therapy would be to put the skin to rest by avoiding irritants. Soap should be restricted towards the critical areas hands, face, axillae, and groin. Excessively hot water is also destructive to the skin. Patients will wish to bathe every day, but extensive soaking might aggravate their skin. Brief, lukewarm showers are acceptable.
Topical corticosteroids are needed for long periods. Therefore, high-potent and super-potent ointments or creams should be limited to flares, and medium-potent or low-potent agents should be used for maintenance. Topical immunomodulators could be helpful in the treatment of AD but should be used with caution because of the current U.S. Food and Drug Administration (FDA) black-box warning on increased threat of neoplasia associated with the use of these agents.
Oral corticosteroids should be reserved for severe flares. Prednisone, 30 mg every day for 10 days, may break the cycle. Colloidal baths initially reduce itching, whereas oral antihistamines relieve pruritus but don't impact the natural course of this chronic dermatitis.
Patients should be encouraged to use unscented moisturizers. Creams or ointments are more efficient than lotions and should be applied immediately after showering to limit irritation and drying, which inevitably results from soap and water. This is especially important in winter. Remember that the sensitivity of patients with AD to wool carries more than into lanolin-based products. Lipid-free products are safest. In hot, humid weather, secondary bacterial infection might need a course of antistaphylococcal oral antimicrobial agents such as erythromycin, 250 mg 3 times every day for 7 to 10 days. KP responds to lactic acid 12% cream or lotion or to urea preparations; both are applied twice every day.
There's no way to know how long AD will last. Frequently, infants and kids have AD that by no means returns in later years. Other patients create AD in middle age; still other people have severe AD for many of their lives. Occasionally, AD surfaces only for certain periods during adulthood. If patients attend to correct skin care, they're less likely to have severe disease if or when the condition recurs.
Our website is not responsible for the information contained by this article. Articleinput.com is a free articles resource thus practically any visitor can submit an article. However if you notice any copyrighted material, please contact us and we will remove the article(s) in discussion right away.
Note: This article was sent to us by: Doris Logleer at 01272011
1. Breast Cancer: how to prevent it and more detailed information
All articles are property of their respective authors. Please read our Privacy Policy!
© 2009 ArticleInput.com.
Partners: Damenmode