Atopic Dermatitis – Diagnosis, Treatment And Complications

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The diagnosis is made mostly on clinical grounds and personal (or)

family history of atopy.

Differential diagnosis:

A number of inflammatory skin diseases Immuno deficiencies, skin

malignancies, genetic disorders, Infections disease and infestations share

symptoms and signs with AD and should be considered and excluded

before a diagnosis of AD is established.

Wiskott-Aldrich syndroms is an X-linked recessive disorder,

associated with thrombocytopenia, Immune defects and recurrent severe

bacterial infections, characterized by a rash almost indistinguishable from

AD.

The hyper IgE syndrome is characterized by markedly elevated

serum IgE levels, recurrent deep seated bacterial infections chronic

dermatitis and reclacitrant dermatophytosis.

Treatment

Most patients can be made to recovers exposures to the causative

agents are prevented.

The child should be bathed once or twice in a day using very small

quantity of soap or non-soap cleanser in bath water. This is done to

prevent drying of epidermis. After bath, he should be palled dry with

towel and emollients and topical medication should be applied on the still

wet skin.

Systemic antibiotics should be given for 7-10 days to treat

secondary infection.

Antinistamins relieve itching and also help in relieving the

inflammation. Systemic steroid therapy is not advisable.

Allergen exacerbating the lesion should be avoided.

Supplementation of diet with large amounts of fish oil containing omega

– 3 fatty acids show favourable results.

Complications

AD is associated with recurrent viral skin infections. The most

serious viral infection is “Kaposi varicelli from eruption or eczema

herpecticm”, which is caused by HSV and affects patients of all ages.

After an incubation period of 5-12 days, multiple, itchy, vesiculopustulus

lesions erupt in a disseminated pattern, the vesicular lesions are

umbilicated, tend to crop, and often become haemorrhagic and crusted.

Persons with AD are susceptible to “eczema vaccination” caused

by Variola virus (small pox), which is similar in appearance to eczema

herpeticum and historically follows small pox vaccination or exposure to

individuals vaccinated with small pox.

Staphylococcus aureus is found on over 90% of AD skin lesions.

Honey coloured crusting, folliculitis, impetigo and pyoderma are

indicators of S. aureus.

Patients with extensive skin involvement may develop exfoliative

dermatitis.

Eyelid dermatitis and chronic blepharitis may result in visual

impairment from corneal scaring.

Atopic keratoconjunctivitis is usually bilateral and can have

disabling symptoms that include itching, burning, tearing and copious

mucoid discharge. Keratoconus is conical deformity of the cornea

believed to result from chronic rubbing of the eyes in-patients with AD.

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