Internal Medicine

P1: SBT

0521779407-05 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:49

Atopic Dermatitis 187

Atopic Dermatitis....................................

J. MARK JACKSON, MD

history & physical

History

■Dry, scaly, itchy, red patches and plaques

■Sensitive skin asthma, hay fever, family history of atopy

Signs & Symptoms

■Erythematous, scaly, thickened (lichenified) patches and plaques

■Flexural areas, creases of extremities, and neck

■Face and diaper areas in infants

tests

■Tests-elevated IgE levels and eosinophils

■No tests necessary

differential diagnosis

■seborrheic dermatitis

■contact dermatitis

■irritant dermatitis

■pityriasis rosea

■drug eruption cutaneous T-cell lymphoma psoriasis

management

What to Do First

■Determine patient discomfort to determine therapy.

■Discontinue skin irritants (fragrances, chemicals, etc.).

General Measures

■Moisturizers (creams/emollients), particularly after bathing

■Relieve itching

specific therapy

■First line – topical emollients, topical corticosteroids, topical

tacrolimus or pimecrolimus, soporific antihistamines (non-sedating

antihistamines have limited benefit)

■Second line – oral/IM corticosteroids, ultraviolet light (either Pso-

ralen+UVA [PUVS], UVB, or narrow-band UVB phototherapy)

■Third line – Methotrexate, cyclosporin, mycophenolate mofetil, or

other immunosuppressives