1) Atopic dermatitis (AD) is a chronic inflammatory skin disease that primarily affects young children and is associated with asthma and allergic rhinitis in many patients. 2) It is caused by a combination of genetic and environmental factors, with filaggrin gene mutations and the hygiene hypothesis playing important roles. 3) Clinically, AD presents with dry, itchy skin that is commonly found on the face and skin folds. Chronic cases show thickened, lichenified plaques.

1. Атопийн дерматит

2. AD is a chronic relapsing inflammatory skin disease
•Primarily affects young children
• More than 50% develop asthma
• 75% developAR
Mark Boguniewicz, Donald Leung.Middleton’s Allergy 7’th edition 893-1999
Introduction

3. Epidemiology
•Affects 15-30% of children, 2-10% of adult
•45% begin within the first 6 mo
•60% begin during the first yr
•85% begin before 5 yrs
•Up to 75%: spontaneous remission before
adolescence
•Үлдсэн 25% нь насанд хүрээд дахидаг. Hand
eczema
•Анх үйлдвэржсэн орнуудад их тохиолдож
байсан.
NJEM 2008;358:1483-94

4. Risk factor
• Genetics
Fillagrin gene mutation
Other gene mutation
• Environment
Hygiene hypothesis

5. Pathophysiology
1. Immunological hypothesis. (hypersensitive 1 )

7. Pathophysiology
2. The Skin Barrier Hypothesis.
• Fillagrin уургийн мутацийн улмаас эвэрлэг давхарга болон мөхлөгт
давхаргын кератиноцит эсүүдийн хоорондын холбоо алдагдана.
(desmosom)
• Barier dysfunction
• Transepidermal water loss
• Үр дүнд нь арьс хуурайшиж, арьсанд аллерген нэвтрэх нь ихэснэ.

8. Morphology

9. Acute AD
• Intensely pruritic, erythematous papule associated with
excoriations, vesiculation, and serous exudate
• Pathology : spongiosis (intercellular epidermal edema), superficial
epidermal hypertrophy and acantholysis
• marked infiltration of CD4 activated memory T cells, APCs,(LCs,
inflammatory dendritic epidermal cells (IDECs), macrophages),
and degranulated mast cell
Histology: Spongiotic area within the epidermis

11. Chronic AD
• thickened plaques with increased lichenification
• Pathology : marked epidermal hyperplasia, acanthosis
• macrophage-dominated mononuclear cell infiltrate in dermis, and
perivascular accumulation of lymphocytes in smaller numbers than
seen in acuteAD
Hyperplastic of epidermis with hyperkeratosis
Adv Immunol.2009;102;135-226

13. Diagnosis
• Essential features Itch
• Eczema with typical morphology and age-specic pattern
Important features
• Early age of onset
Atopy (personal or family history) Dry skin
• Associated features
Atypical vascular response (i.e., facial pallor, white
dermographism)
• Keratosis pilaris, palmar hyperlinearity, ichthyosis Ocular
and periorbital changes
Other regionalndings (e.g., perioral and
periauricular lesions)
• Perifollicular accentuation, lichenification, and excoriations
Modied from American Academy of Dermatology

14. Distribution
• In infants, the face is often affected first, then the
hands and feet; dry red patches may appear all
over the body.
• In older children, the skin folds are most often
affected, especially the elbow creases and behind
the knees.
• In adults, the face and hands are more likely to be
involved.

15. Distribution

21. Atopic
Derm
Adults

22. Atopic Derm Adults

23. Atopic Dermatitis:
Associated features
• The skin is usually dry, itchy & easily irritated by:
• soap
• detergents
• wool clothing
• May worsen in hot weather & emotional stress.
• May worsen with exposure to dust & cats.

24. Associated Findings
• Pityriasis alba

25. Associated Findings
• Xerosis

26. Associated Findings
• Keratosis Pilaris

27. Associated
Findings
• Ichthyosis

28. Differential Diagnosis
• Seborrheic
dermatitis

29. Differential Diagnosis
• Seborrheic dermatitis
• Scabies

30. Differential Diagnosis
• Seborrheic dermatitis
• Scabies
• Drugs

31. Differential Diagnosis
• Seborrheic dermatitis
• Scabies
• Drugs
• Psoriasis

32. Differential Diagnosis
• Seborrheic dermatitis
• Scabies
• Drugs
• Psoriasis
• Allergic contact
dermatitis

33. Differential Diagnosis
• Seborrheic dermatitis
• Scabies
• Drugs
• Psoriasis
• Allergic contact
dermatitis
• Cutaneous T-cell
lymphoma

34. Assessment of severity
• Clear – normal skin no evidence of active atopic
eczema
• Mild – areas of dry skin, frequent itching + - small
areas of redness
• Moderate - areas of dry skin, frequent itching,
redness, +- excoriation and localised thickening.
• Severe – widespread areas of dry skin, incessant
itching, redness (+- excoriation, extensive skin
thickening, bleeding, oozing, cracking.

35. Impact on quality of life
• None – no impact on quality of life
• Mild – little impact on everyday activities, sleep and
psychosocial well being
• Moderate - Moderate impact on everyday activities,
psychosocial well being, frequently disturbed sleep
• Severe – severe limitation of everyday activities and
psychosocial well being, loss of sleep every night

37. Management
• Identify trigger factors
• Irritants – Management
• soaps and detergents
• Contact allergens
• Food allergens
• Inhalant allergens
• Skin infections

40. • Topical treatments
• Corticosteroids
• Calcineur ininhibitors
• Phototherapy
• Ultravioletlight A (UVA)
• Ultravioletlight B (UVB)
• Ultravioletlight A + Psoralene (PUVA)
• Systemic treatments
• Oralcorticosteroids
• Azathioprine
• Cyclosporine A
• Methotrexate

41. Stepped treatment
• Tailor treatment to severity
• Start with emollients – should be used even when skin
clear
• Mild disease – emollients + mild steroid creams 1%
hydrocortisone
• Moderate disease – emollients + moderate steroid
creams. Topical calcineurin inhibitors, bandages.
• Severe disease – potent steroid creams (short periods
only) topical calcineurin inhibitors, bandages,
phototherapy, systemic therapy

42. Management
• Use topical antibiotics + steroid for localised
infection for no longer than 2 weeks
• Non-sedating antihistamines if eczema is severe or
severe itching or urticaria
• Sedating antihistamines children aged > 6/12 during
acute flares if sleep disturbance for child or carers.
• Recognise indications for referral

47. Баярлалаа…