1. Atopic dermatitis is a chronic, inflammatory skin condition characterized by red, itchy rashes. It often begins in childhood and involves skin folds and surfaces like the cheeks, elbows, and knees. 2. The causes involve both genetic and environmental factors like skin barrier dysfunction and immune system abnormalities that make the skin prone to inflammation. Factors like temperature changes, sweating, allergens, and stress can trigger flare ups. 3. Treatment involves moisturizers, bathing, topical corticosteroids for flare ups, and limiting irritant exposure and scratching. Antibiotics may be used if secondary bacterial infection develops but topical antihistamines are not recommended.

1. .
ATOPIC
DERMATITIS
1

2. Dermatitis: greek word- derma +
itis = INFALMMATION OF SKIN
Etymology:
Atopic derived
from atopia in
greek =
UNUSUALNESS
2

3. AN ITCHY, CHRONIC OR
CHRONICALLY RELAPSING SKIN
CONDITION OFTEN STARTING EARLY
IN CHILHOOD WITH RASH
CHARACTERIZED BY ERYTHEMA ,
ITCHY PAPULES/ PAPULOVESICLES
WHICH MAY BECOME EXCORIATED
AND LICHENIFIED .
DEFINITION
3

4. Inside outside model Outside inside model
Skin barrier dysfunction
Immunologic abnormality
in skin
Skin barrier
dysfunction
Epicutaneous
allergen
penetration
Immune system
activation
5
Etiopathgenesis

5. Etiopathogenesis
6
Atopic
dermatitis
Genetics
Immune
dysregulation
Triggers
Microbial
colonizatiom
Hygiene
hypothesis

6. Hygiene Hypothesis
13
 Early childhood infections caused by unhygienic
contact with older siblings confers protection from
development of allergic diseases
 Farm effect- children living on farms, having contact
with farm animals, drinking unprocessed cow`s
milk, increased exposure to microbes have less
incidence of AD and asthma.

7. Trigger factors
14
1) Changes in temperature
2) Sweating
3) Decrease in huminity
4) Contact with irritants
5) Aeroallergens
6) Food allergens
7) Emotional stress
8) harmones

8. Clinical
features
Atopic
dermatitis
Infantile
phase
• Birth to 2
years
• Cheeks
• chin
• forehead
Childhood
phase
• to 12
2
years
• Elbow and
knee folds
• Wrists
• ankles
Adult
phase
• 12 years to
adults
• Flexural
lichenifi
15

9. Infantile phase
16
Childhood phase
17

12. Adult phase
19

13. Pityriasis alba
20

15. Dirty neck appearence
22

17. Hanifin & Rajka criteria for the diagnosis of AD
25
Major criteria( must have three or more)
1. Pruritus
2. Typical morphology & distribution
 Facial/extensor involvement in infants & children
 Flexural lichenification in adults
3. Chronic or chronically relapsing dermatitis
4.Personal or family history of atopy(Asthma, allergic
rhinitis, atopic dermatitis)

18. The UK refinement of Hanifin & Rajka’s
diagnostic criteria of atopic dermatitis(Eczema)
28
Essential criteria
An itchy skin condition(or parental report of scratching or
rubbing in a child)
Plus three more or following:
1. Onset below age of 2 years(not used if child is under 4
years)
2. History of skin crease involvement(including cheeks in
children under 10 years)
3. History of a generally dry skin
4. Personal history of other atopic disease(or history of any
atopic disease in a first-degree relative in children under 4
years)

19. 5. Visible flexural dermatitis(or dermatitis of cheeks/forehead
& outer limbs in children under 4 years)

20. Millennium criteria
29
Mandatory criteria(must be fulfilled)
1. Allergen specific IgE
Principal criteria(must have two or more)
1. Pruritis
2. Typical morphology & distribution
3. Chronic & relapsing course

21. 33
b) Age related characteristics
 Infantile phase-starts on scalp & face, often spreads to
trunk & extremity
 Childhood phase- neck, flexural surface of arms & legs
 Adolescent/adult phase-tendency to be severe, on upper
half of the body
(iii) Chronic or chronically relapsing course:
 More than 2 months in infancy
 More than 6 months in childhood, adolescence &
adulthood

22. AMERICAN ACADEMY OF DERMATILOGY
34
Guidelines of care for
management of AD

23. Recommendation for non pharmacologic interventions for the
treatment of atopic dermatitis
35
 Moisturizers should be an integral part of the treatment.
 Bathing is suggested for the patient with AD as part of
treatment &maintenance
 Moisturizers should be applied soon after bathing
 Limited use of non soap cleansers is recommended
 The additions of oils, emollients & most other additives to
bath waters cannot be recommended
 Use of wet-wrap therapy with or without a topical
corticosteroid can be recommended for patient with
moderate to severe AD to decrease disease severity &
water loss during flares.

24. Recommendation for the use of topical
corticosteroids for the treatment of atopic dermatitis.
36
 Recommended for AD-affected individuals who have
failed to respond to good skin care & regular use of
emollients alone.
 A variety of factors should be considered including patient
age, body area , & other patient factors such as degree of
xerosis, patient preference & cost of medication
 Twice daily application of corticosteroids is generally
recommended
 Proactive intermittent use of topical corticosteroids as
maintenance therapy(1-2 times/wk) on area that
commonly flare is recommended to help prevent relapses

25. & is more effective than use of emollients alone

27. 39
Topical antimicrobials and antiseptics
40
Except for bleach baths with intranasal mupirocin, no
topical antistaphylococcal treatment has been shown
to be clinically helpful in patient with AD & is not
routinely recommended.
In patient with moderate to severe AD & clinical signs
of secondary bacterial infection, bleach baths &
intranasal mupirocin may be recommended to
reduce disease severity

28. Topical antihistamines
41
The use of topical antihistamines for the treatment of
patients with atopic dermatitis is not recommended
because of the risk of absorption & of contact
dermatitis.