Atopic dermatitis

Question 1

When does atopic dermatitis occur?

Answer 1

Very early childhood onset between 2 and 6 months

Question 2

what are the criteria based protocols for atopic dermatitis?

Answer 2

A person who has had an itchy skin condition in the past 12 months plus three or more of the following:

• onset before 2
• history of dry skin
• history of eczema in skin creases (also in cheeks in children under 10)
• Visible flexural eczema (inside elbows, behind knees or involvement of cheeks/forehead and outer limbs in children under 4)
• Personal history of atopic disease

Question 3

What conditions must be elimanated to diagnose atopic dermatitis?

Answer 3

• seborrhoeic dermatitis
• Psoriasis
• contact dermatitis
• Fungal infection

Question 4

what questions should be asked to diagnose atopic dermatitis?

Answer 4

• Is itching present
• Distribution of rash
• Age of child
• Family history of atopy

Question 5

Discuss the relevance of asking a patient with potential atopic dermatitis is itching present?

Answer 5

• AD is commonly associated with INTENSE itching

- Psoriasis and Seborrhoeic dermatitis are not usually associated with itching

Question 6

Discuss the relevance of asking a patient with potential atopic dermatitis about distribution of rash?

Answer 6

• Distribution varies according to age

- Infants have no nappy area involvement thus distinguishes between AD and seborrhoeic dermatitis

Question 7

Discuss the relevance of asking a patient with potential atopic dermatitis Age of child?

Answer 7

presentation varies with age

• babies: facial involvement (the cheeks) is common along with patchy red scaly lesions on wrists and hands
• toddlers and older children: antecubital, popliteal fossae and ankles more commonly involved

Question 8

Discuss the relevance of asking a patient with potential atopic dermatitis about family history of atopy?

Answer 8

If a parent has ECZEMA, HAY FEVER or ASTHMA, likelihood of AD rises.

Question 9

When do you refer dermatitis?

Answer 9

• children with moderate or severe AD
• medication failure- patient suffers 2 or more flare ups per month
• Presence of secondary infection (weeping or crusting lesions)

Question 10

How would you explain to a patient on how to avoid irritants?

Answer 10

• highly perfumed soaps and detergents should be discouraged and replaced with soap substitutes (Dove or neutrogena)
• patients advised to have lukewarm baths rather than hot baths as hot water can aggravate the the problem
• A bath additive should be used to help skin hydration

Question 11

What does first line treatment of atopic dermatitis entail?

Answer 11

• Removal of irritants

- Use of an emollient

Question 12

What are some general tips that would be provided

Answer 12

• avoid scratching, keep nails short and rub fingers to alleviate itch to avoid skin trauma
• Emollients containing lanolin (E45 and keri lotion etc..) should be avoided as they are known to cause sensitisation.
• emollients are best applied when the skin is moist, during bath times apply as frequently as possible.
• The more oily an emollient the more effective they tend to be