3. Definition of Terms
Dermatitis is an inflammatory epidermal rash.
Atopy: tendency to develop one or more of a group of conditions such as
allergic rhinitis, asthma, eczema, skin sensitivities or urticaria.
Atopic dermatitis (eczema): genetically transmitted inflammatory skin
disease that disrupts skin barrier and its ability to hold moisture.
4. EPIDEMIOLOGY
Onset of the disease is by five years of age.
Highest incidence is between 3 to 6 months.
60% of patients develop the disease within the first year of life.
90% will develop it by 5 years of age.
Commonly resolves by the time child reaches adulthood.
Only 16% of patients with Atopic Dermatitis are diagnosed after
adolescence.
5. EPIDEMIOLOGY…cont
Age(years) Global (%) Africa (%) Middle East (%)
6-7 14.2 23.3 7.2
13-14 12.8 15.8 12.8
Adapted from International Study for Asthma and Allergy in Childhood (ISAAC)
phase 3. Prevalence of Atopic Dermatitis.
6. EPIDEMIOLOGY…cont
In Kenya prevalence of atopic dermatitis was found to be
28.5% in children aged 13-14 years in 2002 compared to
13.9% in 19951.
Risk Factors
1. Family history 2
2. Environmental factors e.g. urban vs rural dwelling,
obesity, breastfeeding, diet, obesity, pollution.3
7. CLINICAL PRESENTATION
Itch
Usually a family history of atopy.
Often known trigger factor.
Typical morphology and distribution of skin lesions.
Dry skin
Chronic relapsing dermatitis.
13. MANAGEMENT
Advice parents of affected child to:
Avoid soap and perfumed products. Use soap substitutes e.g. cleansers
and shampoos with low Ph.
Apply an emollient soon after bath.
Short tepid showers for older children.
Avoid rubbing and scratching, use gauze bandages with hand splints for
infants.
Keep fingernails short.
Avoid overheating particularly at night.
14. MANAAGEMENT…cont
Avoid wool next to the skin.
Keep skin moisturized with emollients.
Dust mite strategies e.g. dust mite covers, wash linen in hot water and
consider changing fabric on chairs and changing carpets.
15. MEDICATION…cont
Mild Atopic Dermatitis
1. Soap substitutes – choose clensers and shampoo with low pH (4.5-6).
2. Emollients e.g. Cetomacrogol, Bennets, Physiogel etc.
3. 1% hydrocortisone if not responding to the above OD or BD. (short term
for flares)
Moderate Atopic Dermatitis
1. As for mild (1&2)
2. Topical corticosteroids (moderate strength to trunk and limbs and weaker
strength to face and flexures, no longer than 2 weeks)
16. MEDICATION…cont
3. Non steroidal alternative (Topical pimecrolimus) BD for facial dermatitis. Best
for flares then cease.
Oral antihistamines generally have no role in the treatment of atopic
dermatitis, however, a sedating antihistamine at night is appropriate if itch
prevents sleep.
Severe Dermatitis
1. As for mild and moderate eczema.
2. Potent topical corticosteroids (+/-occlusive dressing in affected areas.)
3. Consider hospitalization.
4. Systemic corticosteroids.
18. DIFFERENTIAL DIAGNOSIS
Seborrhoeic Dermatitis Eczema
Age of onset Mainly within 3 months Usually after 2 months
Itchiness Nil or mild Usually severe
Distribution Scalp, cheeks, folds of neck,
axillae, folds of elbows and
knees.
Starts on face, elbow and
knee flexures.
Typical features Cradle cap, red and yellow
greasy scale.
Vesicular and weeping.
Becomes dry and cracked.
Napkin rash Common, prone to
infection with Candida.
Less common.
Other features May become generalized. May become generalized.
19. SEBORRHOEIC DERMATITIS
Seborrhoeic dermatitis is a very common skin inflammation that usually
affects areas abundant in sebaceous glands or intertriginous areas. It is
therefore common in hair-bearing areas of the body, especially the scalp
and eyebrows. It can also affect the scalp, face, neck, axillae and groins,
eyelids , external auditory meatus and nasolabial folds. The presternal area
is often involved.
There are two distinct clinical forms: seborrhoeic dermatitis of infancy, and
the adult form.
21. CRADLE CAP
Cradle cap is infantile seborrhoeic dermatitis confined to the scalp. The
seborrhoeic dermatitis may also involve other areas. Cradle cap
is very common, usually occurring in the first 6 weeks of life and settling
over the next few weeks to months, but it sometimes takes much longer.
Greasy yellow scales are formed in response to sebum combining with old
skin cells as they try to dry and fall off. The yeast Malassezia furfur may be
involved. It is not usually itchy or distressing to the child
23. TREATMENT OF CRADLE CAP
Reassurance and watchful waiting (if not too bad, given the natural history
is to improve with time)
Use vegetable oil overnight to soften scales and then gently brush off (not
olive oil; this encourages Malassezia)
Baby shampoos and then gentle brushing off of scales
2% ketoconazole shampoo (Nizoral) twice weekly
Apply hydrocortisone cream to red and inflamed areas
25. TREATMENT CONTI…
TREATMENT2
Scalp
First line treatment is an anti-fungal shampoo applied often (twice per
week to daily).
If inadequate, add a topical corticosteroid lotion for 7 nights.
If inadequate response and especially if thick scale, refer to a specialist ,
coal tar (LPC) maybe added at night, once or twice weekly and wash off the
next morning with anti-fungalshampoo.
26. CONTACT DERMATITIS
Acute contact dermatitis can either be irritant or allergic.
FEATURES INCLUDE:
Itchy inflamed skin.
Redness and swelling
Papulovesicular lesions
May be dry and fissured
27.
28. REFERRENCES
1. 1.Esamai F1, Ayaya S, Nyandiko W.Prevalence of asthma, allergic
rhinitis and dermatitis in primary school children in Uasin Gishu
district, Kenya. East Afr Med J. 2002 Oct;79(10):514-8.
2. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387:1109–
3. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann
Nutr Metab. 2015;66(Suppl 1):8–16
4. John Murtagh’s general practice 6th and 7th edition
29. Thank you!
The power of making a correct diagnosis is the key to all success in the
treatment of skin diseases; without this faculty, the physician can never be
a thorough dermatologist, and therapeutics at once cease to hold their
proper position, and become empirical.
LOUIS A DUHRING (1845–1913)
