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Eczema / Atopic Dermatitis

Atopic dermatitis (AD) is a chronic itchy inflammatory skin disorder that affects about 10% of children to some extent. Many children with AD develop other symptoms of atopy such as food allergies, asthma, and allergic rhinitis (hayfever). When inhaled or ingested allergens enter the bloodstream they can be carried to the skin, where they induce a chronic inflammation -- know as atopic dermatitis – in sensitized (atopic) individuals who possess T cells and IgE specific for an allergen. Allergens that act by direct skin contact can also incite inflammation. The immunologic response of the skin to antigen is complex, resulting in inflammation and localized tissue destruction. This chronic inflammation is called eczema and is the most prominent symptom of atopic dermatitis.

Diagnosis

History in infancy, clinical findings (typical distribution sites, morphology of lesions, while dermatographism).

Physical Examination

Acute
Poorly defined erythematous patches, papules, and plaques with or without scale. Edema with widespread involvement; skin appears “puffy” and edematous. Erosions: moist, crusted. Linear or punctuate, resulting from scratching. Secondarily infected sites: S. aureus. Oozing erosions and/or pustules (usually follicular).
Chronic
Lichenification (thickening of the skin with accentuation of skin markings): results from repeated rubbing or scratching. Fissures: painful, especially in flexures, on palms, fingers, and soles. Alopecia: lateral one-third of the eyebrows as a result of rubbing. Characteristic infraorbital fold in the eyelids (Dennie-Morgan sign).