Atopic dermatitis is a chronic and inflammatory disease of the skin that affects 5-20% of children worldwide. It is associated with elevated IgE levels and/or a family history of atopy. Common atopic conditions include eczema, asthma, and allergic rhinitis.
Clinical Manifestations
The cardinal signs of atopic dermatitis are significant pruritus and dry skin. Other symptoms include dry and scaly erythematous papules, vesicles, and plaques. Patients may develop lichenification and fissures from chronic scratching. In patients with darker complexions, lesions may appear darker brown, gray, or violaceous when compared to the erythema of lighter complected individuals.
Differential Diagnoses
Other conditions to consider when seeing a patient with suspected atopic dermatitis include contact dermatitis, psoriasis, scabies, seborrheic dermatitis, and drug eruptions.
Treatment
There are a variety of treatment options available via topical, oral, and injectable routes. The goals of treatment are to minimize pruritus, decrease dermatitis, prevent exacerbations, and manage risks associated with therapy.
Mild-to-moderate disease – topical corticosteroids, topical calcineurin inhibitors, crisaborole, topical ruxolitinib
Moderate-to-severe disease – phototherapy, biologics, JAK inhibitors, cyclosporine, methotrexate
Treat skin infections often related to Staphylococcus aureus and herpes simplex. Antihistamines may be used for pruritus. Maintaining skin hydration is very important in managing atopic dermatitis. Patients need to apply emollients at least two times per day and immediately after bathing. Thick creams and ointments with low to zero water content are preferred over lotions.
Written by Sara Doherty, APRN