Medicine 6th year, Dermatology Tutorial (5th session/part two)
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  • 1. Atopic Dermatitis
  • 2. AD: ICCAD II
    • AD is a common chronic relapsing inflammatory skin disease characterized by:
    • Intense itching.
    • Dry skin.
    • Inflammation.
    • Exudation.
    • Physical & emotional distress for pts. and their families.
    • > psoriasis.
    • = early onset of DM.
  • 3. AD: ICCAD II (Cont’d)
    • Early age of onset:
    • 50% of cases diagnosed by 1 year of age.
    • 1/3 of patients having persistent disease throughout adulthood.
    • Vast majority of cases are mild.
  • 4. AD: ICCAD II (Cont’d)
    • AD is often familial and frequently associated with asthma, food allergy, allergic rhinitis and recurrent 2ry skin infections.
    • AD may increase subsequent risk or severity of asthma.
  • 5. AD: ICCAD II (Cont’d)
    • Trigger factors:
    • Increased prevalence: 10-15% of children (<yrs) are affected.
    • Stress.
    • Irritants.
    • Microbes, and
    • Allergens.
  • 6. III-Diagnosis Atopic Dermatitis
  • 7. AD: Clinical features Infantile phase (2 months – 2 years)
    • Cheeks, forehead and body but sparing the diaper area.
    • Erythema, itchy edematous papules with rubbing  exudative & crusted.
    • 2ry infection and lymphadenopathy.
  • 8. AD: Clinical features (Cont’d) Childhood phase (2 – 12 years)
    • Elbow and knee flexures, sides of neck and hand.
    • Itchy papules and lichenified plaques.
    • Scratching  lichenification.
  • 9. AD: Clinical features (Cont’d) Adult phase (? atopic neurodermatitis)
    • As childhood phase with lichenification of flexures.
    • Hand dermatitis, upper eyelid dermatitis.
    • Dry skin and keratosis pilaris.
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  • 34. Hanifin & Rajak’s diagnostic criteria for AD (1980) Major criteria
    • Adults: flexural lichenification or linearity.
    • Children and infants: facial, extensor.
    1. Pruritus. 2. Typical morphology and distribution 3. Chronic or relapsing dermatitis. 4. Personal or family history of atopy.
  • 35. Hanifin & Rajak’s diagnostic criteria for AD (Cont’d) Minor criteria 1. Xerosis. 2. Ichythosis, keratosis pilaris, palmar hyperlinearity. 3. Type I skin test reactivitiy. 4. Elevated serum IgE. 5. Early age at onset. 6. Tendency to skin infections. 7. Infraorbital darkening and linearity. 8. Atypical vascular responses.
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