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атопийн дерматит
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- 2. AD is achronic 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% ofchildren, 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 Fillagringene mutation Other gene mutation • Environment Hygiene hypothesis
- 5. Pathophysiology 1. Immunological hypothesis.(hypersensitive 1 )
- 7. Pathophysiology 2. The SkinBarrier 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.
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- 9. Acute AD • Intenselypruritic, 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 • thickenedplaques 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 featuresItch • 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.
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- 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.
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- 29. Differential Diagnosis • Seborrheicdermatitis • Scabies
- 30. Differential Diagnosis • Seborrheicdermatitis • Scabies • Drugs
- 31. Differential Diagnosis • Seborrheicdermatitis • Scabies • Drugs • Psoriasis
- 32. Differential Diagnosis • Seborrheicdermatitis • Scabies • Drugs • Psoriasis • Allergic contact dermatitis
- 33. Differential Diagnosis • Seborrheicdermatitis • 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 qualityof 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 triggerfactors • 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 • Tailortreatment 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 topicalantibiotics + 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
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