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Key Features

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  • Results from an interaction among susceptibility genes, the host environment, skin barrier defects, pharmacologic abnormalities, and immunologic response

  • The case for food and inhalant allergens as specific causes of atopic dermatitis is not strong

  • There is significant evidence that a primary defect in atopic dermatitis is an abnormality in the skin barrier formation due to defects in the filaggrin gene

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Clinical Findings

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  • Many (not all) patients go through three clinical phases

    • Infantile

    • Childhood or flexural

    • Adolescent

  • Infantile eczema

    • Begins on the cheeks and scalp and frequently expresses itself as oval patches on the trunk, later involving the extensor surfaces of the extremities.

    • Usual age at onset is 2–3 months

    • Phase ends at age 18 months to 2 years

  • Childhood or flexural eczema

    • Only one-third of all infants with infantile eczema progress to childhood or flexural eczema

    • Predominant involvement is in the antecubital and popliteal fossae, the neck, the wrists, and sometimes the hands or feet

    • Phase lasts from age 2 years to adolescence

  • Adolescent eczema

    • Only one-third of children with typical flexural eczema progress to adolescent eczema

    • Manifests with continuation of chronic flexural eczema along with hand and/or foot dermatitis

  • Atopic dermatitis unusual after age 30 years

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Diagnosis

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  • Clinical

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Treatment

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  • Acute stages

    • Application of wet dressings and medium-potency topical corticosteroids for acute, weeping atopic eczema

    • Appropriate systemic therapy may be necessaryfor superinfection with Staphylococcus aureus, Streptococcus pyogenes, orherpes simplex virus

  • Chronic stages

    • Avoiding irritants and restore water to the skin

    • No soaps or harsh shampoos should be used

    • Avoid woolen or any rough clothing

    • Bathing is minimized to every second or third day

    • Twice-daily lubrication of the skin is very important

    • A bedroom humidifier is often helpful

    • Tacrolimus and pimecrolimus ointments are topical immunosuppressive agents that are effective

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