Atopic dermatitis

most common type of dermatitis, introduction, epidemiology, pathophysiology, diagnosis, treatment

1. Atopic Dermatitis Insp Dr Mahadev Deuja Wednesday, May 30, 2018

2. Outline Introduction Classification Atopic dermatitis Introduction Epidemiology Clinical features Complications Diagnosis Treatment

3. Introduction Dermatitis- a distinctive inflammatory response of the skin, secondary to a number of exogenous or endogenous factors Not a single health condition but a recognizable reaction pattern seen in a number of skin diseases. Red, swollen, itchy and painful skin lesion Dermatitis = eczema synonymously and interchangeably

4. Etiological classification of dermatitis Endogenous Exogenous Combined Seborrheic dermatitis Irritant dermatitis Atopic dermatitis Numullar dermatitis Allergic dermatitis Pompholix Lichen simplex chronicus Photodermatitis Pityriasis alba Radiation dermatitis Stasis dermatitis Infective dermatitis

5. Atopic dermatitis Most common type of dermatitis A chronic, pruritic , inflammatory skin disease with a wide range of severity Non contagious Primary symptom is pruritus (itch) Hallmark of disease Most debilitating symptom AD is often called “ the itch that rashes ” Scratching to relieve itch gives rise to the ‘itch-scratch’ cycle and can exacerbate the disease

6. Usually develops AD in infancy or early childhood. However can appear at any stage of life. Patients experience periods of remission and exacerbation Often for unexplained reasons. Tooth erruptions , psychoemotional or stressful events are common known triggers Often improves towards 5-6y of age. Exacerbation Remission

7. Pathophysiology of AD Multifactorial condition whose etiology is not entirely understood.

8. Disruption of skin Barrier function Defective renewal of the stratum corneum Water can easily get out out skin – dry skin Allergen and infectious agents can easily get in Prone for infection IgE reactivity

9. Molecular basis of skin barrier dysfunction Multiple molecular abnormalities have been identified Most important being reduced levels of the protein filaggrin An important structural component of the stratum corneum Others are Reduced level of the source of natural moisturizing factor (NMF). Mixture of small molecules that bind water and help maintain skin hydration. Reduced levels of ceramides -- waxy lipids that are also important for preventing water loss. Tight junction formation also appears to be defective

10. Epidemiology The prevalence rate for atopic dermatitis (AD) is 10-12% in children and 0.9% in adults (US). Race AD affects persons of all races. Sex The male-to-female ratio for AD is 1:1.4. Age In 85% of cases, AD occurs in the first year of life In 95% of cases, it occurs before age 5 years.

11. Symptoms of AD Varies Significantly from one individual to another With the age of the patient Between flare-up and remission

12. Phases of AD 60% 40%

13. Clinical findings Lesions typically begin as erythematous papules Which then coalesce to form erythematous plaques that may display weeping, crusting, or scaling May often get infected causing pustules

14. Infantile phase

15. Childhood phase

16. Adult phase

17. Evolution of AD…… Patients with AD often experience an "atopic march,“ i.e early AD gives way to food allergy, allergic rhinitis and asthma later in life. Clinical evaluation

18. Concerns for skin infections Skin is prone for infection Staphylococcus aureus is common in AD lesions Can trigger inflammation Appears as crusts or pustules Other possible infections Eczema herpiticum Coxsackievirus Molluscum contagiosum (warts) crusts pustules

19. AAD 2014 guidelines (modifications to Hanifin-Rajka criteria)

20. Pearls of AD Treatment The current therapeutic options for AD is not curative. Approach should be Individualized because of varied clinical presentations and disease burdens. Dynamic to respond to changes over time.

21. Objective of Treatment Exacerbation Remission

22. Treatment during exacerbation Exacerbation Remission

23. Treatment during remission

24. Take home message AD is a chronic, pruritic , inflammatory skin disease with a wide range of severity The pathogenesis of AD is multifactorial Genetics skin barrier dysfunction impaired immune response and the Environmental factor play a role Diagnosis is mainly clinical Itching Early age of onset Age wise distribution Comes and goes Treatment for AD includes long-term use of emollients and gentle skin care as well as short-term treatment for acute flares

25. Mcq’s Which of the following statements supports the diagnosis of atopic dermatitis: Chronic nature of the rash Distribution of the rash Family history of atopic disease Symptom of pruritus All of the above

26. Is atopic dermatitis contagious? Yes No

27. Refrences India E. Illustrated Synopsis of Dermatology and Sexually Transmitted Diseases. 2011. emedicine.com. Accessed May 28, 2018]. Khanna N. Bhutani’s Color Atlas of Dermatology. Jaypee Brothers,Medical Publishers Pvt. Limited; 2015.

28. Thank you