In this article, we will discuss Dermatitis Atopica (Clinical Features). So, let’s get started.
Atopic Dermatitis (Dermatitis Atopica) is a very itchy and chronic disease that mainly affects children with a history of familial atopy. 60% of cases manifest in the first year of life and 85% before the age of 5 years and in more than 40% of cases they heal before reaching adults.
There are 3 clinical varieties according to age groups in Atopic Dermatitis:
a) Atopic dermatitis of the infant: It affects children from 1 month to 2 years, characterized by a pruritic eczema-like rash, which affects the face, scalp and neck. The most characteristic is erythema on the cheeks, with or without microvesiculation, exudation, serous or blood crusts and final desquamation. The perioral and periorbital areas and the nasal vertex are respected.
The retroauricular and infraauricular folds are frequently involved, the scalp can also be affected and presents with itching, erythema and scaling. The involvement of extensor areas, the back of the hands, the back of the feet and the trunk is classic, without involvement of the genital area. Secondary bacterial superinfection is common at this age. These children are in good general condition, but the intense itching makes them irritable and with very bad sleep.
b) Atopic dermatitis of the child: This stage ranges from the age of 2 years to 12 years. It corresponds to a continuum of the infant phase, or it may manifest de novo at this age. At this age the clinical manifestations are different, they are less exudative and are characterized by lichenified plaques in flexural areas, especially the antecubital and popliteal fossa and the volar aspect of the wrists, ankles and neck. Prurigo-like clinical forms are common at this age, with exsoriated papules with vesicles or micro-crusts on their surface, in the extensor areas of the extremities.
c) Atopic dermatitis of the adolescent-adult: This stage includes patients older than 12 years, who have been atopic since childhood or start the disease at this age. Dermatitis is more localized and lichenified and has a distribution similar to that of the infantile phase. Compromise of the hands and feet is common. The skin is thickened and chafed in the affected areas, mainly the flexural areas (neck, antecubital area and popliteal fossa), other sites that are affected are the face, scalp, wrists and forearms.
In all stages, severe cases can become general, reaching erythroderma.
Atopic Dermatitis is a disease that affects the quality of life of children and their families, mainly in its most severe forms.
The clinical and cutaneous manifestations of an atopic diathesis are very frequent in AD carriers, but by themselves they do not make the diagnosis of AD.
The manifestations are:
1) Non-eczematous cutaneous clinical signs:
a) Xerosis or xeroderma: dry skin with peeling.
b) Keratosis pilaris: located on the arms and thighs or extensive to the back of the trunk.
c) Ptiriasis alba: Asymptomatic hypopigmented plaques 2 to 3cm in diameter, dry appearance, slightly scaly. They are located in the cheeks, extensor areas of the arms and the upper part of the back that are exacerbated during and after the summer.
d) Dennie-Morgan line. Infraorbital fold present in 27% of patients.
e) Neck skin folds and increased palmar lines.
F) Delayed whitening. 70% of the cases.
g) Facial paleness and acral coldness.
h) White dermographism: 80% of cases.
The symptoms and clinical manifestations of AD are:
a) Chronic pruritus: It is the main symptom of the disease and is a major diagnostic criterion for Atopic Dermatitis, if it is not present, the diagnosis of Atopic Dermatitis is questioned. It is defined as an unpleasant sensation of the skin that causes a scratching response. It has been linked to the release of multiple inflammatory mediators, some of them not yet identified.
The intensity of the itching is variable, from mild to moderate to severe, it usually occurs in outbreaks and can be localized or generalized depending on the extent and severity of the lesions. As a secondary effect to itching, traumatic lesions are generated by grating that frequently become superinfected with streptococci or staphylococcus aureus. Pruritus can be triggered by multiple factors (stress, environmental, food, infections, contactants, etc …) and it has been shown that atopic patients have greater skin reactivity to irritants than non-atopic patients.
b) Infra-atrial, retroauricular and infranasal fissures: It occurs in 98% of severe cases. A sensitive fissure with erythema of the affected fold is observed, it is frequently over-infected and is secondary to scratching and poor drying of the area. They present as a fissure of the affected fold with surrounding finely scaly erythema; some authors consider them pathognomonic for AD.
c) Dermatitis of the hands and feet: 70% of children with Atopic Dermatitis have palmoplantar dermatitis, characterized by thickening and dryness of the palms and / or soles with or without involvement of the back of the hands and feet. A variant of this entity is juvenile plantar dermatitis that occurswith bright, scaly and sometimes fissured erythema of the palms and soles, respecting interdigital folds.
d) Lichen simplex chronicus: Areas of lichenification due to scratching or permanent friction secondary to itching. It occurs mainly in areas of extension in the extremities and Nipple eczema: It is more frequent in female adolescents, it presents as a very itchy and exudative dermitis on both nipples, up to 20% of patients are described.
F) Cheilitis: Especially of the upper lip, usually restricted to the vermilion border of the lips, but can spread to the perioral area. It begins during childhood and presents as dry, scaly lips during winter. Saliva used to relieve dryness and sticky scales exacerbates the problem.
g) Dermatitis of the eyelids: Erythema and desquamation that can evolve to lichenification, usually bilateral. If the scratching is very intense and continuous, eyebrows and eyelashes may be lost. Present in 8 to 23% of patients with AD. They can coexist with blepharitis and conjunctivitis. On rare occasions, cataracts and que-rats may be seen