Atopic DermatitisAtopic Dermatitis

AD: ICCAD II

• AD is a common chronic relapsing inflammatory skin disease characterized by:

Intense itching.

Dry skin.

Inflammation.

Exudation.

Physical & emotional distress for pts. and their families.

- > psoriasis.

- = early onset of DM.

AD: ICCAD II (Cont’d)

• Early age of onset:

50% of cases diagnosed by 1 year of age.

1/3 of patients having persistent disease throughout adulthood.

• Vast majority of cases are mild.

AD: ICCAD II (Cont’d)

• AD is often familial and frequently associated

with asthma, food allergy, allergic rhinitis

and recurrent 2ry skin infections.

• AD may increase subsequent risk or severity

of asthma.

AD: ICCAD II (Cont’d)

• Trigger factors:

• Increased prevalence: 10-15% of children

(<yrs) are affected.

Stress.

Irritants.

Microbes, and

Allergens.

III-DiagnosisIII-Diagnosis

Atopic DermatitisAtopic Dermatitis

AD: Clinical features

Infantile phase (2 months – 2 years)

• Cheeks, forehead and body but sparing the diaper

area.

• Erythema, itchy edematous papules with rubbing

exudative & crusted.

• 2ry infection and lymphadenopathy.

AD: Clinical features (Cont’d)

Childhood phase (2 – 12 years)

• Elbow and knee flexures, sides of neck and

hand.

• Itchy papules and lichenified plaques.

Scratching lichenification.

AD: Clinical features (Cont’d)

Adult phase (? atopic neurodermatitis)

• As childhood phase with lichenification of

flexures.

• Hand dermatitis, upper eyelid dermatitis.

• Dry skin and keratosis pilaris.

Hanifin & Rajak’s diagnostic criteria for

AD (1980)

Major criteria

• Adults: flexural lichenification or linearity.

• Children and infants: facial, extensor.

1. Pruritus.

2. Typical morphology and distribution

3. Chronic or relapsing dermatitis.

4. Personal or family history of atopy.

Hanifin & Rajak’s diagnostic criteria for AD (Cont’d)

Minor criteria

1. Xerosis.

2. Ichythosis, keratosis pilaris, palmar hyperlinearity.

3. Type I skin test reactivitiy.

4. Elevated serum IgE.

5. Early age at onset.

6. Tendency to skin infections.

7. Infraorbital darkening and linearity.

8. Atypical vascular responses.