Professional Documents
Culture Documents
I.
children.
B.
C.
D.
lesions that look very much like atopic dermatitis. After the age of
mediators.
Triggering factors
E.
2. IgE
have respiratory symptoms into adult life. If you have a patient that
5. Inflammation
6. Pruritus
7. Acute dermatitis
A number of immunologic factors as well as inflammatory
8. Chronic dermatitis
F.
of the skin [i.e. rubbing and excoriation) produces many of the symptoms of
acute and chronic dermatitis. Dermatitic changes in the skin result in further
Clinical presentation.
for diagnosis)
least two)
least four)
Pruritus
Ichthyosis, xerosis,
of atopy
hyperlinear palms
Pityriasis alba
Keratosis pilaris
White dermographism
Anterior subcapsular
cataracts
flare of their atopic dermatitis, you will see acute changes in the
skin. Patients with chronic changes will have lichenification or
accentuation of the normal skin margins with thickening of the
epidermis. These patients will have excoriation and pigmentary
change. They will have scale. These changes suggest a process
which has been ongoing for days if not weeks or months. Again,
you can see this in association with the acute changes when the
patient has acute flares of their atopic disease.
Hand dermatitis
Repeated cutaneous
infections
Age related patterns will help you make the diagnosis. In infancy,
all areas of the skin fair game for presentation of the skin lesions
with the exception of protected areas. The diaper area is
invariably spared until the patients are toilet-trained. Then you
Greasy-ness
Petrolatum
More Greasy
start to see lesions in the diaper area and this is a reliable finding.
Widespread disease affects the head and neck, the extremities.
The trunk may be relatively spared because it is a relatively
protected site. This child has both some acute changes of
erythema and scaling and crusting. This child has some chronic
Mineral oil
Eucerin cream
the arms and legs because the flexural creases are actually
Keri lotion
Lubriderm lotion
exactly the opposite of what you see in a slightly older child. The
Cetaphil lotion
LactiCare lotion
Nutraderm lotion
G.
Less greasy
atopic dermatitis.
H.
Differential Diagnosis
1. Seborrheic dermatitis
2. Irritant dermatitis
3. Papular acrodermatitis
4. Psoriasis
5. Fungal infection
6. Scabies
J.
1. Lubricants
3. Topical steroid
4. Environmental control measures
5. Antibacterials
6. Foods?
7. Allergy Rx?
Group
Generic name
Trade name
Potency
Clobetasol propionate
High potency
Betamethasone dipropionate
Amcinonide
Betamethasone dipropionate
Diflorasone diacetate
Halog cream O. 1%
Halcinonide
Fluocinonide
Fluocinonide
Diflorasone diacetate
Desoximetasone
Betamethasone valerate
Triamcinolone acetonide
Flurandrenolide
Betamethasone dipropionate
Betamethasone benzoate
Triamcinolone acetonide
atopic disease.
Fluocinolone acetonide
5
Triamcinolone acetonide
Flurandrenolide
Fluocinolone acetonide
Kenalog cream O. 1%
Triamcinolone acetonide
Fluocinolone acetonide
Betamethasone valerate
Hydrocortisone valerate
Alphaderm cream 1%
10%
Flumethasone pivalate
about, you can ask their parents to roll up their pants and roll up
their sleeves and see the same thing. You have a 50-50 shot of
Desonide
having it with the parent who brings the kid to see you.
Hydrocortisone 1%
Hytone cream 1%
Hydrocortisone 1%
Hytone ointment 1%
Dexamethasone
atopics. You see the sand-papery papules on the arms and legs
Methylprednisolone
and people present with this a couple of ways. You may see it as
a concomitant finding in atopics. You may see it in the summer
Prednisolone
8
Hydrocortisone 0.5%
Low potency
may also see it during the winter when their skin tends to be dry,
when their eczema tends to flare up and when the sand-papery
References
Hanifin JM: Basic and clinical aspects of atopic dermatitis: a review. Ann Allergy
Pityriasis alba. Pityriasis alba, which translates directly into
52:368-375, 1984.
Hanifin JM, Lobitz WC: New concepts of atopic dermatitis. Arch Dermatol, 113:663,
1977.
some fine scale. Many of them will have some finer or more subtle
Leung D, Rhodes R, Geha RS: Atopic dermatitis, in Fitzpatrick TB, Eisen ZA, Wolff K,
atopic dermatitis.
If you have a patient with an acute process and you give them a
water-based product, it may sting and burn. So, it is important that
you consider the vehicle. If you have a patient that develops some
sort of an adverse reaction to the topical preparation, in may in
fact not be the medicated product at all. It may be one of the
components of the vehicle. So you need to look carefully at the
"inert" ingredients.
a general rule, they are much less expensive. You can also
control the time for which they are applied. If you have a
combination product, you buy into everything being put on at the
same time. If you have a combination product and a patient has
an adverse reaction, develops contact dermatitis, again you don't
know which medicated product is producing the problem and
you're stuck with having to discontinue the product. Cost
considerations. I suggest that you go to your local pharmacy and
see what they have. There may be certain topical corticosteroids
which they have available in a large quantity, which they have
available in an ointment based product, which is what I generally
use in atopic patients. I think it is reasonable to look and see what
is available and pick out an agent or two in the low potency range
and the middle potency range that you become very comfortable
with.