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ATOPIC DERMATITIS - a #dermatology #tweetorial/#medthread!
For all the #tweetiatricians, #primarycare, #medtwitter, & #dermtwitter! #MedEd #FOAMEd pc:@dermnetnz
1st, a question:
How do you think of the term atopic dermatitis (AD) in relation to the term eczema?
ATOPIC DERMATITIS - a #dermatology #tweetorial/#medthread!
For all the #tweetiatricians, #primarycare, #medtwitter, & #dermtwitter! #MedEd #FOAMEd pc:@dermnetnz
1st, a question:
How do you think of the term atopic dermatitis (AD) in relation to the term eczema?
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If you're a purist, "eczema" is a description. When a #dermatologist says something looks eczematous, it doesn't mean it's AD. It means it has a certain appearance.
So the right answer for purists is "AD can cause eczema."
That said, we so often just use eczema to mean AD🤷🏻♂️
If you're a purist, "eczema" is a description. When a #dermatologist says something looks eczematous, it doesn't mean it's AD. It means it has a certain appearance.
So the right answer for purists is "AD can cause eczema."
That said, we so often just use eczema to mean AD🤷🏻♂️
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As annoying as that might be, it's an important distinction. If you see an eczematous rash, you need to consider possible causes:
- Atopy
- Allergy/irritant contact
- Medications
- Venous stasis
- Dry skin
For more on contact dermatitis, check out @patchtestYu!
As annoying as that might be, it's an important distinction. If you see an eczematous rash, you need to consider possible causes:
- Atopy
- Allergy/irritant contact
- Medications
- Venous stasis
- Dry skin
For more on contact dermatitis, check out @patchtestYu!
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So what exactly does an "eczematous dermatitis" look like?
We see these weepy, scaly, red, plaques. The scale can looks like "collarettes," which means a little circle. That's because it's a footprint for an old vesicle, since the acute form can have many vesicles!
So what exactly does an "eczematous dermatitis" look like?
We see these weepy, scaly, red, plaques. The scale can looks like "collarettes," which means a little circle. That's because it's a footprint for an old vesicle, since the acute form can have many vesicles!
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The chronic form of the eruption looks a little different. The constant rubbing/scratching because of the itch causes lichenification to happen. On exam, we see accentuated skin markings.
So how might you differentiate AD from the other causes of eczema?
The chronic form of the eruption looks a little different. The constant rubbing/scratching because of the itch causes lichenification to happen. On exam, we see accentuated skin markings.
So how might you differentiate AD from the other causes of eczema?
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In AD, the distribution helps. The flexures are typical in adults, and the hands and feet are often involved.
Things change in #pediatrics. In babies, it can be anywhere, including the face and extensor sides of the limbs.
For any age group, severe eczema can be all over!
In AD, the distribution helps. The flexures are typical in adults, and the hands and feet are often involved.
Things change in #pediatrics. In babies, it can be anywhere, including the face and extensor sides of the limbs.
For any age group, severe eczema can be all over!
7/ In addition to the distribution, the history helps too. The atopic triad is key. Asking about personal and family history of atopic dermatitis, seasonal allergies, and asthma is helpful in figuring out the likelihood of an AD diagnosis.
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Let's do a mid-#tweetorial recap:
- Eczematous dermatitis is a rash pattern, described as weepy, erythematous plaques that started vesicular, and can become lichenified.
- You have to figure out the cause!
- AD has a particular distribution and history. Patient age matters!
Let's do a mid-#tweetorial recap:
- Eczematous dermatitis is a rash pattern, described as weepy, erythematous plaques that started vesicular, and can become lichenified.
- You have to figure out the cause!
- AD has a particular distribution and history. Patient age matters!
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Let's keep going! The pathophysiology for AD isn't super clear, but some cases are linked with a filaggrin mutation.
What we do know is that AD changes epidermal barrier function. That means difficulty holding onto moisture and fending off infections!
jacionline.org/article/S0091-…
Let's keep going! The pathophysiology for AD isn't super clear, but some cases are linked with a filaggrin mutation.
What we do know is that AD changes epidermal barrier function. That means difficulty holding onto moisture and fending off infections!
jacionline.org/article/S0091-…
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As you might expect, because of the underlying problems, we focus on the following:
1 - Dry skin care
2 - Treating any superinfection
3 - treating the inflammation
We'll discuss numbers 1 and 2 soon, but for treating inflammation, check out👇🏻
As you might expect, because of the underlying problems, we focus on the following:
1 - Dry skin care
2 - Treating any superinfection
3 - treating the inflammation
We'll discuss numbers 1 and 2 soon, but for treating inflammation, check out👇🏻
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Dry skin care is critical. I give my patients a "dry skin care" info sheet. I've included it here if it's helpful.
This is important, as dry skin itself can cause "asteototic eczema!" This has a "dry river bed" appearance (see pic) and is also called "eczema craquele."
Dry skin care is critical. I give my patients a "dry skin care" info sheet. I've included it here if it's helpful.
This is important, as dry skin itself can cause "asteototic eczema!" This has a "dry river bed" appearance (see pic) and is also called "eczema craquele."
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In regards to superinfection, because of the downregulation of certain molecules in the skin immune milieu (cathelicidins, HBDs), atopic skin is much more likely to get superinfected than psoriasis.
Cool @nejm article from 2003: nejm.org/doi/10.1056/NE…
In regards to superinfection, because of the downregulation of certain molecules in the skin immune milieu (cathelicidins, HBDs), atopic skin is much more likely to get superinfected than psoriasis.
Cool @nejm article from 2003: nejm.org/doi/10.1056/NE…
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So AD that is impetiginized will get some topical antibiotics as well. Also, with flares, bleach baths are commonly used to treat the overall burden of superficial pathogens.
Notice that yellow honey colored crust in the picture! You almost never see this in psoriasis!
So AD that is impetiginized will get some topical antibiotics as well. Also, with flares, bleach baths are commonly used to treat the overall burden of superficial pathogens.
Notice that yellow honey colored crust in the picture! You almost never see this in psoriasis!
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So what if all that fails? Call your local dermatologist for help! We have a lot more in our armamentarium, like:
- aggressive topical therapy (wet wraps, "AD bootcamp")
- phototherapy
- methotrexate
- mycophenolate
- dupilumab
So what if all that fails? Call your local dermatologist for help! We have a lot more in our armamentarium, like:
- aggressive topical therapy (wet wraps, "AD bootcamp")
- phototherapy
- methotrexate
- mycophenolate
- dupilumab
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SUMMARY:
- Treatment focuses on dry skin care, treating inflammation, and treating superinfection.
- Dry skin itself can cause "asteototic eczema."
- AD tends to get superinfected.
- Dermatologists can do a lot more if your treatment options for your AD patients are limited!
SUMMARY:
- Treatment focuses on dry skin care, treating inflammation, and treating superinfection.
- Dry skin itself can cause "asteototic eczema."
- AD tends to get superinfected.
- Dermatologists can do a lot more if your treatment options for your AD patients are limited!
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One caveat: I'm not a #pediderm, so I'll let my #dermtwitter colleagues fill in the rest for the pediatric population if they have some more to add (@patchtestYu, @leoshmu)!
Thanks for joining me today! Hope this was helpful for some of you out there in #medtwitter!
One caveat: I'm not a #pediderm, so I'll let my #dermtwitter colleagues fill in the rest for the pediatric population if they have some more to add (@patchtestYu, @leoshmu)!
Thanks for joining me today! Hope this was helpful for some of you out there in #medtwitter!
