Key Points

• Atopic dermatitis is a common inherited childhood disorder that may occur with other atopic conditions such as allergic rhinitis and asthma.

• Topical steroids and emollients are the mainstays of treatment for AD.

• Topical and systemic antibiotics are used for AD secondarily infected with bacteria.

Atopic dermatitis (AD) is a potentially debilitating condition that can compromise quality of life. Its most frequent symptom is pruritus. Pruritus leads to scratching, resulting in secondary skin changes such as lichenification, excoriation, and breakdown of the skin barrier. Consequently, atopic dermatitis has been referred to as "the itch that rashes."

Atopic dermatitis is a common problem affecting up to 15% of all children. In most cases, AD occurs before 5 years of age, frequently on the face in the first year of life (Fig. 33-4). As children grow, the antecubital and popliteal fossae are often involved (Fig. 33-5). The disease may occur

Figure 33-4 Atopic dermatitis. (e Richard P. Usatine.)
Figure 33-5 Atopic dermatitis in antecubital fossa. (e Richard P. Usatine.)

intermittently between periods of complete remission. By adulthood, the incidence becomes less than 1%. Treatment should be directed at limiting itching, repairing the skin, and decreasing inflammation. Lubricants and topical corti-costeroids are the mainstays of therapy. Topical pimecroli-mus or tacrolimus are considered steroid-sparing agents and are effective for short-term use or in cases unresponsive to topical corticosteroids. These agents are only approved for second-line treatment in patients over 2 years of age. When required for severe cases, oral corticosteroids can be used. If pruritus does not respond to treatment, other diagnoses, such as bacterial overgrowth or viral infections, should be considered.

Always look for signs of bacterial superinfection, such as weeping of fluid and crusts (Fig. 33-6). Superinfection with Staphylococcus aureus may lead to worsening of atopic dermatitis as the bacteria functions as a super antigen. S. aureus superinfections are usually sensitive to methicillin, so oral cephalexin is frequently a good choice for treatment. Bleach baths are helpful to cut down on colonization. (Add V2 cup regular bleach per full tub of lukewarm water and soak for 5 to 10 minutes before washing off bleach water.)

Figure 33-6 Impetiginized atopic dermatitis. (e Richard P. Usatine.)

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Curing Eczema Naturally

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