LocationSigns2 monthsChest, faceRed, raised vesicles; dry skin; oozing2 yearsScalp, neck and extensor surface of extremitiesLess acute lesions; edema; erythema2 – 4 yearsNeck, wrist, elbow, kneeDry, thickened plaques; hyperpigmentation12 – 20 yearsFlexors, handsDry, thickened plaques; hyperpigmentationDiagnosis of ADItchy skin condition + 3 or more of the following:Onset at <2 yoHistory of skin crease involvement Cheeks, neck, eyes, anklesPersonal history of other atopic diseaseHistory of generally dry skinVisible flexural dermatitisElbowsBehind knees
9/30/20165Atopic Dermatitis PathophysiologyIntense itch-scratch cycle3 types of skin lesionsAcute: pruritic, erythematous papules and vesiclesSubacute: thick, pale, scaly, excoriated plaquesChronic: thickened plaques, accentuated skin markings and fibrotic papulesExacerbating FactorsSoapsDetergentsChemicalsTemperature changesDustPollenFoodsEmotional changesComplicationsSecondary Cutaneous infectionsStaphylococcus aureusStreptococciSeek Medical Attention ifPustulesVesiclesCrustingHerpes SimplesAtopic Dermatitis TreatmentGoals of Therapy1.Maintain skin hydration 2.Relieve or minimize symptoms of itching and weeping3.Avoid or minimize factors that trigger or aggravate the disorderGeneralized AD Treatment ApproachSkin hydrationTrigger avoidanceAs with allergy managementInflammatory reliefAntipruritic reliefWeeping vesicles reliefAD Treatment – Skin HydrationAcute/Subacute ADBathe every other dayBathe 3-5 minutesPat dry after bathingSoap choiceApply moisturizers within 3 minutesControl WeepingChronic ADSame as Acute/Subacute ADOintments preferred for long term control
9/30/20166Inflammatory ReliefTopical CorticosteroidsHydrocortisone 0.5-1%MOALikely suppresses cytokines associated with inflammation and itchingHow to applySparingly to affected
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Cutaneous conditions, dry skin, Local anesthetic, Atopic dermatitis