​Dermatology - Atopic Dermatitis / Atopic Eczema

​Dermatology - Atopic Dermatitis / Atopic Eczema 
Atopic dermatitis, often known as eczema, typically starts during infancy and reaches its highest occurrence rate of 15-20% in early childhood. Frequently, there exists a familial background of atopy, allergic rhinitis, or asthma.
Triggers encompass aeroallergens, particularly dust mites and pollen; microorganisms; autoallergens; food items, notably eggs, milk, peanuts, soybeans, fish, and wheat; clothes, specifically wool.
Flares can be triggered by stress and are more prevalent during the winter season and after disrobing.

Pruritus is an essential characteristic of eczema, often described as "the itch that rashes." The persistent act of scratching results in a relentless loop of itch → scratch → rash → itch → scratch.
Abnormalities
Erythematous patches, papules, and plaques with ill-defined borders may exhibit scaling and edema. Scratching can lead to the formation of moist and crusty erosions, which may indicate a secondary infection if they are oozing.
Chronic cases might result in the development of lichenification and fissures, which can cause pain. Follicular lichenification can develop, particularly in individuals with deeply pigmented skin. Friction can lead to eyebrow hair loss, darkening of the skin around the eyes, and the formation of a fold below the eyelids known as the Dennie-Morgan sign.


The diagnosis is established through an evaluation of the patient's medical history and a thorough clinical examination. The differential diagnosis comprises seborrheic dermatitis, contact dermatitis, psoriasis, nummular eczema, dermatophytosis, and early mycosis fungoides. Additional uncommon conditions to consider are acrodermatitis enteropathica, glucagonoma syndrome, histidinemia, phenylketonuria, and some immunologic abnormalities.

Instruct patients to refrain from rubbing and scratching, utilize emollients, and take measures to prevent subsequent infection. Administer wet dressings, topical glucocorticoids, and topical antibiotics as necessary, and utilize hydroxyzine to alleviate pruritus. To treat subacute and chronic cases, recommend bathing with oil or oatmeal powder, using unscented emollients, and applying topical anti-inflammatories like glucocorticoids, hydroxyquinoline, or tar. Glucocorticoids exhibit the highest level of effectiveness, while their extended usage may result in negative effects. Tacrolimus and pimecrolimus are highly effective in treating mild exacerbations and subacute cases of atopic dermatitis. Ultraviolet A-Ultraviolet B phototherapy or narrow band UV (311 nm) and PUVA photochemotherapy may also provide positive results.