Atopic dermatitis in Adult
See also in: Cellulitis DDx,External and Internal EyeAlerts and Notices
Synopsis
In infants, the disease involves primarily the face, scalp, torso, and extensor aspects of extremities. In children and adults, the disease usually involves chiefly the flexural aspects of extremities, but it may be more generalized. In adults, flexural skin may be clear and disease may be focal or widespread. Follicular patterns of atopic dermatitis (ie, follicular eczema) are more common in persons with darker skin phototypes.
Atopic dermatitis may be categorized as follows:
- Acute – erythema, vesicles, bullae, weeping, crusting
- Subacute – scaly plaques, papules, round erosions, crusts
- Chronic eczema – lichenification, scaling, hyper- and hypopigmentation
Intense pruritus (itching) is a hallmark of atopic dermatitis. Scratching leads to lichenification (skin thickening from chronic trauma). Impaired barrier function leads to increased water loss and cutaneous infections. Patients with atopic dermatitis are prone to impetiginization with Staphylococcus aureus. Secondary infections with herpes simplex virus (eczema herpeticum), Coxsackie viruses (eczema coxsackium), or vaccinia virus (eczema vaccinatum) may transpire.
Patients with atopic dermatitis have difficulties in retaining skin moisture and suffer from xerosis (dry skin). Environmental triggers, such as heat, humidity, detergents / soaps, abrasive clothing, chemicals, smoke, and even stress, tend to aggravate the condition. Latex allergy and nickel allergy occur more often in persons with atopic dermatitis. Additionally, patients with atopic dermatitis have been found to be more likely to have positive patch test results to products commonly found in topical treatments, including cocamidopropyl betaine, wool alcohol / lanolin, and tixocortol pivalate. Allergy to eggs, cow's milk, or peanuts is common. There may be a relationship between atopic dermatitis and the development of aspirin-related respiratory disease.
Codes
ICD10CM:L20.9 – Atopic dermatitis, unspecified
SNOMEDCT:
24079001 – Atopic dermatitis
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Differential Diagnosis & Pitfalls
- Allergic contact dermatitis
- Irritant contact dermatitis
- Nummular dermatitis (nummular eczema)
- Eczema craquelé
- Tinea corporis
- Psoriasis
- Pityriasis rosea
- Seborrheic dermatitis
- Lichen simplex chronicus
- Ichthyosis vulgaris
- Scabies
- Pityriasis rubra pilaris
- Secondary syphilis
- Glucagonoma syndrome
- Pellagra
- Mycosis fungoides – If an adult patient has persistent "eczema" that is not adequately responding to therapy, this entity should be ruled out with skin biopsies.
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Last Reviewed:02/19/2017
Last Updated:11/09/2022
Last Updated:11/09/2022
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Atopic dermatitis in Adult
See also in: Cellulitis DDx,External and Internal Eye