Atopic Dermatitis

Eczema includes atopic dermatitis, irritant dermatitis (due to water, detergents, chemicals, heat), and allergic contact dermatitis. The lifetime incidence of atopic dermatitis is 15-20%, with an equal distribution between the sexes. I. Atopic Dermatitis

A. Atopic dermatitis usually first appears in infants 2-6 months of age. Infants and children have rashes on the shoulders, chest, abdomen, and back. Infants usually also have a rash on the face, scalp and around the ears. Children older than 18 months old tend to have rashes on the neck and antecubital and popliteal fossae.

B. Atopic dermatitis usually resolves by puberty, but it sometimes recurs at times of stress. In adults it may appear as recalcitrant hand eczema or as a localized dermatitis.

C. Acute lesions of atopic eczema are itchy, red, edematous papules and small vesicles which may progress to weeping and crusting lesions. Chronic rubbing and scratching may cause lichenification and hyperpigmentation.

D. The classic triad of atopy consists of asthma, allergic rhinitis, and atopic dermatitis . Atopic dermatitis is associated with a personal or family history of atopy.

Precipitating Factors and Activities in Atopic Dermatitis

Moisture-related

Excessive bathing, excessive hand washing, excessive lip licking, excessive sweating, extended showers or baths, repeated contact with water (eg, work-related), swimming, occlusive clothing and footwear

Contact-related

Overuse of soap, bubble-bath, cosmetics, deodorants, detergents, solvents, tight clothing, rough fabrics, wool or mohair

Temperature-related

Exposure to excessively warm environment, high humidity, overdressing, hot showers or baths, heating pad

Emotional

Anger, anxiety, depression, stress

Infective

Bacteria, fungi, viruses

Inhalational

Animal dander, cigarette smoke, dust, perfume

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