A child with itchy skin lesions with extensor distribution on skin, elbow and mother gives h/o bronchial asthma diagnosis?
Ans. is 'a' i.e., Atopic dermatitis Presence of itchy erythematous vesicobullous lesions on extensor distribution and history of allergy in mother suggests atopic dermatitis.Normally in atopic dermatitis lesions occur in "flexural distribution" but when atopic dermatitis occurs in infants, the lesions tend to occur in "extensor distribution ".Atopic dermatitis is associated with allergy: - * Although there has been some controversy with regard to the role of allergy in atopic dermatitis (eczema) the bulk of the data indicate that allergy plays a role in selected patients in atopic dermatitis.Patients with atopic dermatitis have higher rates of allergic diseases than the general population.Lip to 80% of children with atopic dermatitis develop asthma and/or allergic rhinitis later in childhood.The converse is true as well, a higher rate of atopic dermatitis is seen in teenagers with asthma than those without asthma.Atopic dermatitis is also associated with elevated serum IgE.A high total serum IgE level is a strong risk factor for atopic dermatitis in children from birth to six years of age.Age group -Most patients have manifestation of atopic dermatitis by age 5-7 yrs.Atopic dermatitisFirst year of life in 60% casesBy the age 5 years in 85% casesIt will clear in 40% of patients by adulthood.There are three age group stages of atopic dermatitisInfantile - from infancy to 2 years oldChildhood - 2 yrs -12 yearsAdult stage - Older than 12 yearsLesions in atopic dermatitis vary according to the age of the patientIn infants - intensely pruritic erythematous patches with papules extensor distribution, Involvement of scalps face.In older individuals and chronic lesion - They are characterized by thickened skin increased skin markings (lichenification) and excoriated and fibrotic papules. COURSE OF ATOPIC DERMATITIS Seborrheic dermatitisIt is characterized by erythematous and scaly patches in areas that are rich in sebaceous glands such as scalp, face and upper trunk.ScabiesThe clinical features of infantile scabies is quite similar to infantile atopic dermatitis.Presence of heavy involvement of palms and soles suggests scabies.Infantile atopic dermatitis does not involve the palms and soles.In scabies there would be history of similar lesions in other family members while in Atopic dermatitis there would be history of allergic disorders in other family members.
Atopic dermatitis
Air borne contact dermatitis
Scabies
Allergic contact dermatitis
Eosinophilic Dermatoses