Page 93 - The Netter Collection of Medical Illustrations - Integumentary System_ Volume 4 ( PDFDrive )

Plate 4-8 Rashes

INFANTS AND CHILDREN WITH ATOPIC DERMATITIS
Infant with atopic dermatitis

ATOPIC DERMATITIS

Atopic dermatitis is one of the most common dermato-
ses of childhood. It typically manifests in early life and
can have varying degrees of expression. It is commonly Child with atopic dermatitis Lymphadenopathy in a
associated with asthma and allergies. Most children child with atopic dermatitis
eventually outgrow the condition. Atopic dermatitis
has been estimated to affect up to 10% of all children
and 1% of adults, and its prevalence has been steadily
increasing. Patients frequently have a family history of
atopic dermatitis, asthma, or skin sensitivity.
Clinical Findings: Atopic dermatitis typically begins
early in life. There is no racial predilection. The clinical
course is often chronic, with a waxing and waning
nature. Infants a few months old may initially present
with pruritic, red, eczematous patches on the cheeks
and extremities as well as the trunk. The itching is typi-
cally severe and causes the child to excoriate the skin,
which can lead to secondary skin infections. The skin
of atopics is abnormally dry and is sensitive to heat
and sweating. These children have difficulty sleeping
because of the severe pruritus associated with the rash.
During flares of the dermatitis, patients may develop
weeping patches and plaques that are extremely pruritic
and occasionally painful. With time, the patches begin
to localize to flexural regions, particularly the antecu-
bital and popliteal fossae. Severely afflicted children
may have widespread disease. Patients with atopic der-
matitis are more prone to react to contact and systemic
allergens. Sensitivity to contact allergens is likely a con-
sequence of the frequent use of topical medicaments Frontal view Dorsal view
and the broken skin barrier. This combination leads to
increased exposure to foreign antigens that are capable
of inducing allergic contact dermatitis. One should
suspect a coexisting contact dermatitis if a patient who
is doing well experiences a flare for no apparent reason
or if a patient continues to get worse despite aggressive
topical or oral therapy. Laboratory testing commonly
shows an eosinophilia and an elevated immunoglobulin
E (IgE) level.
Secondary infection is common in atopic dermatitis. the general public. The rate of colonization of atopic perfect environment for the development of this wide-
It may manifest with the appearance of honey-colored, patients is much higher than in normal controls, most spread viral infection.
crusted patches in the excoriated regions, which likely because of the disruption of the underlying Most childhood atopic dermatitis resolves spontane-
indicates impetigo. It may also manifest as multiple epidermis. Colonization in certain situations may ously over time. It is estimated that 10% of cases will
follicle-based pustules, representing folliculitis, or lead to infection. Acquisition of a widespread herpesvi- resolve by the age of 1 year, 50% by 5 years, 70% by 7
as deep red, tender macules, indicating a deeper rus infection can have severe and potentially life- years, and so on. A small percentage of children with
soft tissue infection. The rate of methicillin-resistant threatening consequences. Atopics are much more atopic dermatitis continue on with the rash into adult-
Staphylococcus aureus (MRSA) infection has increased in prone than others to develop eczema herpeticum. The hood. These cases tend to be chronic in nature and to
patients with atopic dermatitis at the same rate as in extensive areas of abnormal, broken skin provide the last for the patient’s lifetime.

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