Atopic%20dermatitis Signs and Symptoms

• 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, eczema, or neurodermatitis
• One of the most common skin diseases afflicting both children and adults
• Prevalent in 2-10% of young adults and up to 20% in children
• Estimated to be present in 2-5% of adult
• Common causes include allergens such as food, soaps, detergents, inhalant allergens and skin infections

• Heredity (80% in monozygous twins, 20% in heterozygous twins)
• Increased immunoglobulin E (IgE) production in some individuals
• Presence of inherited loss-of-function defects in the filaggrin (FLG) gene increase the risk of developing atopic dermatitis
  • FLG is proteolyzed in the upper layers of the stratum corneum to produce the skin’s natural moisturizing factor (NMF)
• Lack of skin barrier and impairment of moisture retention capacity produce dry skin due to abnormalities in lipid metabolism and protein formation thus allowing entry of allergens, antigens and chemicals from the environment
• 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

• Pain was shown to be the second most common symptom of atopic dermatitis after pruritus in an international web-based survey from 34 countries 
  • Related to scratching, skin fissures, inflamed red skin or from burning from topical medications (eg steroids)

Infants <2 Years of Age

• Signs of inflammation usually develop during the third month of life
• Patient commonly presents with red, scaling, dry skin
  • Lesions (red papules with oozing, crusting and scaling) 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
• 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 of Age

• Inflammation in the flexural areas
  • Eg neck, wrists, ankles, antecubital fossae
• Rash may be contained to 1 or 2 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
• Scratching and chronic inflammation may lead to areas of hypo- or hyperpigmentation

13 Years Old - Adults

• Resurgence of inflammation that recurs near puberty onset
• Eruptions more likely develop on the upper body including the face, neck, chest and back, with additional involvement of the face and neck, and prurigo on the trunk and extremities
  • In severe cases, rare erythroderma may occur due to extension of eruptions all over the body
• It is unusual for adults with no history of dermatitis in earlier years to present with new-onset dermatitis
• Pattern of inflammation is similar as in a child 2-12 years with additional lesions on nape and hands
• Hand dermatitis may be present in the adult due to exposure to irritating chemicals
• Dry, scaling, erythematous papules and plaques