Introduction
- One of the most common skin diseases afflicting both adults and children
- Infant’s skin has a developing epidermal barrier and would only fully mature at least at first year of age thus their skin absorb more water and lose excess water faster than adult skin
- This skin characteristic makes them susceptible to irritation and infections
Definition
- A familial, chronic relapsing inflammatory skin disease characterized by intense itching, dry skin, with inflammation and exudation that commonly presents during early infancy and childhood, but can persist or start in adulthood
- Also referred to as “atopic eczema”
Etiology
- Common causes include allergens such as food, soaps, detergents, inhalant allergens and skin infections
Pathophysiologic Features
- Heredity (80% in monozygous twins, 20% in heterozygous twins)
- Increased immunoglobulin E (IgE) production
- Lack of skin barrier producing dry skin due to abnormalities in lipid metabolism and protein formation
- Susceptibility to infections caused by Staphylococcus aureus/epidermidis and Malassezia furfur through abnormal microbial colonization
- Decreased diversity of the cutaneous microbiome secondary to S aureus colonization is significantly associated with atopic dermatitis flare-up
Signs and Symptoms
Infants <2 Years Old
- Signs of inflammation usually develop during the third month of life
- Patient commonly presents with red, scaling, dry areas
- Usually found on the facial cheeks and/or chin
- Lip licking may result in scaling, oozing and crusting on the lips and perioral skin, eventually leading to secondary infections
- Perioral and perinasal sparing can be characteristic and patient may present with no lesions in these areas
- Continued scratching or washing will create scaling, oozing, red plaques on cheeks
- Infant may be restless or agitated during sleep
- A small number of infants may present with generalized eruptions
- Papules, redness, scaling and lichenification
- Diaper area is usually not affected
Children 2-12 Years Old
- Inflammation in the flexural areas
- Eg neck, wrists, ankles, antecubital fossae
- Rash may be contained to one or two areas
- May progress to involve more areas (eg neck, antecubital and popliteal fossae, wrists and ankles)
- Papules that quickly change to plaques then lichenified when scratched
- Constant scratching may lead to excoriations and eventual areas of hypo- or hyperpigmentation
Adolescents ≥12 Years Old
- Resurgence of inflammation that recurs near puberty
- Pattern of inflammation is the same as in a child 2-12 years
- Dry, scaling, erythematous papules and plaques