5-Minute Clinical Consult

Dermatitis, Atopic

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Basics

Description

  • A chronic, relapsing, pruritic eczematous condition affecting characteristic sites
  • Although called atopic, most children with the typical clinical presentation will not have a measurable IgE-mediated sensitivity to allergens.
  • System(s) affected: Skin/Exocrine

Epidemiology

Environmentally triggered in susceptible individuals


Incidence
  • 45% of all cases begin in the first 6 months of life.
  • 70% of affected children will have a spontaneous remission before adolescence.
  • Incidence on the rise for the past 3 decades; overall, affects ∼15% of children at some time (US).
Prevalence
  • Also may have late-onset dermatitis in adults
  • Asians and blacks affected more often than whites
  • 60% if 1 parent affected; rises to 80% if both parents affected

Etiology and Pathophysiology

  • Alteration in stratum corneum results in transepidermal water loss and defect in barrier function.
  • Epidermal adhesion is reduced either as a result of: (a) Genetic mutation resulting in altered epidermal proteins or (b) defect in immune regulation causing an altered inflammatory response.
  • Interleukin-31 (IL-31) upregulation is thought to be a major factor in pruritus mediated by cytokines and neuropeptides rather than histamine excess (1).

Genetics
  • Arises from gene–gene and gene–environment interactions
  • Both epidermal and immune coding likely involved

Risk Factors

  • “Itch-scratch cycle” (stimulates histamine release)
  • Skin infections
  • Emotional stress
  • Irritating clothes and chemicals
  • Excessively hot or cold climate
  • Food allergy in children (in some cases)
  • Exposure to tobacco smoke
  • Family history of atopy:
    • Asthma
    • Allergic rhinitis

Commonly Associated Conditions

  • Food sensitivity/allergy in many cases
  • Asthma
  • Allergic rhinitis
  • Hyper-IgE syndrome (Job syndrome):
    • Atopic dermatitis
    • Elevated IgE
    • Recurrent pyodermas
    • Decreased chemotaxis of mononuclear cells

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