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FERRI’S FAST FACTS IN DERMATOLOGY
A Practical Guide to Skin Diseases and Disorders
ISBN: 978-1-4377-0847-9
Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
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is book and the individual contributions contained in it are protected under copyright by the Publisher (other than as
may be noted herein).
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any
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e Publisher
Library of Congress Cataloging-in-Publication Data
Ferri, Fred F.
Ferri’s fast facts in dermatology : a practical guide to skin diseases and disorders / Fred F. Ferri ; associate editors,
James S. Studdiford, Amber Tully.—1st ed.
p. ; cm.
ISBN 978-1-4377-0847-9
Includes index.
1. Skin—Diseases—Handbooks, manuals, etc. 2. Skin—Diseases—Atlases. I. Studdiford, James S. II. Tully,
Amber. III. Title. IV. Title: Fast facts in dermatology.
[DNLM: 1. Skin Diseases—Handbooks. WR 39 F388f 2011]
RL74.F47 2011
616.5—dc22
2009025859
e patient images without a credit line were taken from the following collections:
e Honickman Collection of Medical Images in memory of Elaine Garfinkel
e Jefferson Clinical Images Collection (through the generosity of JMB, AKR, LKB, and DA)
Acquisitions Editor: Jim Merritt
Developmental Editor: Nicole DiCicco
Project Manager: Bryan Hayward
Design Direction: Steven Stave
Printed in China
Last digit is the print number:
9
8
7
6
5
4
3
2
1
Third Line
■ Pentoxifylline
■ Oral acyclovir
Chapter from:
Clinical
Pearl(s)
Ferri’s Fast Facts
in Dermatology:
A Practical Guide to Skin Diseases and Disorders
■
Some conditions often associated with the minor variant include Behçet’s
Atopic Dermatitis
syndrome, inflammatory bowel disease, and gluten
sensitivity. (Atopic Eczema)
15. ATOPIC DERMATITIS (ATOPIC ECZEMA)
FIGURE 03-030. Dry, erythematous, scaling skin
on the palm of this patient during a flare of his
atopic dermatitis. Also note fissuring and bleeding
secondary to pruritus and scratching.
FIGURE 03-031. Marked erythema, secondary
excoriations, and edema of the skin overlying the
lateral neck. Skin crease accentuation (hyperlinear
DISEASES
AND DISORDERS
71
creases)
is also evident.
FIGURE 03-032. Thickened, inflamed, scaling skin FIGURE 03-033. Chronically inflamed, pruritic,
in the small of the back that was refractory to
hyperpigmented skin in the antecubital fossa with
treatment.
lichenification and excorciations secondary to
excessive scratching.
General Comments
Definition
■ Atopic dermatitis is a genetically determined eczematous eruption that is pruritic,
symmetric, and associated with personal family history of allergic manifestations (atopy).
■ Diagnosis is based on the presence of three of the following major features and
three
minor features.
Copyright © 2011
by Saunders
an imprint of Elsevier Inc. All rights reserved.
Major Features
■ Pruritus
1
Chapter from:
Ferri’s Fast Facts in Dermatology: A Practical Guide to Skin Diseases and Disorders
2
FIGURE 03-032. Thickened, inflamed, scaling skin FIGURE 03-033. Chronically inflamed, pruritic,
in theAtopic
small of
the back that
was refractory
hyperpigmented skin in the antecubital fossa with
Dermatitis
(Atopic
Eczema)to
treatment.
lichenification and excorciations secondary to
excessive scratching.
General Comments
Definition
■ Atopic dermatitis is a genetically determined eczematous eruption that is pruritic,
symmetric, and associated with personal family history of allergic manifestations (atopy).
■ Diagnosis is based on the presence of three of the following major features and
three minor features.
Major Features
■ Pruritus
■ Personal or family history of atopy: asthma, allergic rhinitis, atopic dermatitis
■ Facial and extensor involvement in infants and children
■ Flexural lichenification in adults
Minor Features
■ Elevated IgE
■ Eczema-perifollicular accentuation
■ Recurrent conjunctivitis
72Ichthyosis
Atopic Dermatitis (Atopic Eczema)
■
■ Nipple dermatitis
■ Wool intolerance
■ Cutaneous S. aureus infections or herpes simplex infections
■ Food intolerance
■ Hand dermatitis (nonallergic irritant)
■ Facial pallor, facial erythema
■ Cheilitis
■ White dermographism
■ Early age of onset (after 2 months of age)
Etiology
■ Unknown. Elevated T-lymphocyte activation, defective cell immunity, and B-cell
IgE overproduction may play a significant role.
Keys to Diagnosis
Clinical Manifestation(s)
■ There are no specific cutaneous signs for atopic dermatitis, and a wide spectrum of
presentations are possible, ranging from minimal flexural eczema to erythroderma.
■ Inflammation in the flexural areas and lichenified skin is a very common
presentation in children.
Physical Examination
■ The primary lesions are a result of scratching caused by severe and chronic pruritus.
The repeated scratching modifies the skin surface, producing lichenification, dry
and scaly skin (Fig. 03-030), and redness.
■ Lesions are typically found on the neck (Fig. 03-031), face, upper trunk,
and bends of elbows and knees (symmetric on flexural surfaces of
extremities).
Copyright © 2011
by Saunders an imprint of Elsevier Inc. All rights reserved.
■ There is dryness, thickening of the involved areas (Fig. 03-032), discoloration,
blistering, and oozing.
■ Papular lesions are frequently found in the antecubital and popliteal fossae.
Food intolerance
Hand dermatitis (nonallergic irritant)
■ Facial pallor, facial erythema
■ Cheilitis
Chapter■ from:
White dermographism
■ Early age of onset (after 2 months of age)
Ferri’s Fast
Facts in Dermatology: A Practical
■
■
Guide to Skin Diseases and Disorders
Etiology
Atopic Dermatitis (Atopic Eczema)
Atopic Dermatitis (Atopic Eczema)
3
■ Unknown. Elevated T-lymphocyte activation, defective cell immunity, and B-cell
IgE overproduction may play a significant role.
Keys to Diagnosis
Clinical Manifestation(s)
■ There are no specific cutaneous signs for atopic dermatitis, and a wide spectrum of
presentations are possible, ranging from minimal flexural eczema to erythroderma.
■ Inflammation in the flexural areas and lichenified skin is a very common
presentation in children.
Physical Examination
■ The primary lesions are a result of scratching caused by severe and chronic pruritus.
The repeated scratching modifies the skin surface, producing lichenification, dry
and scaly skin (Fig. 03-030), and redness.
■ Lesions are typically found on the neck (Fig. 03-031), face, upper trunk,
and bends of elbows and knees (symmetric on flexural surfaces of
extremities).
■ There is dryness, thickening of the involved areas (Fig. 03-032), discoloration,
blistering, and oozing.
■ Papular lesions are frequently found in the antecubital and popliteal fossae.
■ In children, red scaling plaques are often confined to the cheeks and the perioral
and perinasal areas.
■ Constant scratching may result in areas of hypopigmentation or hyperpigmentation
(Fig. 03-033) (more common in African Americans).
■ In adults, redness and scaling in the dorsal aspect of the hands or around the
fingers are the most common expression of atopic dermatitis; oozing and crusting
may be present.
■ Secondary skin infections may be present (S. aureus, dermatophytosis, herpes
simplex).
Diagnostic Tests
DISEASES AND DISORDERS
73
■ Skin biopsy can be performed.
■ Laboratory tests are generally not helpful.
■ Elevated IgE levels are found in 80% to 90% of patients with atopic dermatitis.
■ Blood eosinophilia correlates with disease severity.
Differential Diagnosis
■
■
■
■
■
■
■
■
Scabies
Psoriasis
Dermatitis herpetiform
Contact dermatitis
Photosensitivity
Seborrheic dermatitis
Candidiasis
Lichen simplex chronicus
Treatment
First Line
■ Avoidance of triggering factors:
Copyright © 2011 by Saunders an imprint of Elsevier Inc. All rights reserved.
● Sudden temperature changes, sweating, low humidity in the winter
● Contact with irritating substance (e.g., wool, cosmetics, some soaps and
detergents, tobacco)
3
Chapter from:
Ferri’s Fast Facts in Dermatology: A Practical Guide
to Skin
Diseases and73Disorders
DISEASES
AND DISORDERS
4
■
■
Atopic Dermatitis
Eczema)
Elevated
IgE levels (Atopic
are found
in 80% to 90% of patients with atopic dermatitis.
Blood eosinophilia correlates with disease severity.
Differential Diagnosis
■
■
■
■
■
■
■
■
Scabies
Psoriasis
Dermatitis herpetiform
Contact dermatitis
Photosensitivity
Seborrheic dermatitis
Candidiasis
Lichen simplex chronicus
Treatment
First Line
■ Avoidance of triggering factors:
● Sudden temperature changes, sweating, low humidity in the winter
● Contact with irritating substance (e.g., wool, cosmetics, some soaps and
detergents, tobacco)
● Foods that provoke exacerbations (e.g., eggs, peanuts, fish, soy, wheat, milk)
● Stressful situations
● Allergens and dust
● Excessive hand washing
■ Clip nails to decrease abrasion of skin.
■ Emollients can be used to prevent dryness. Severely affected skin can be
optimally hydrated by occlusion in addition to application of emollients.
■ Topical corticosteroids may be helpful.
Second Line
■ Topical immunomodulators pimecrolimus and tacrolimus are effective steroid-free
treatments.
■ Oral antihistamines can help with itching.
Third Line
■ Oral prednisone, intramuscular triamcinolone, Goeckerman regimen, and PUVA
are generally reserved for severe cases.
Clinical Pearl(s)
■
The highest incidence is among children (5%-10%). More than 50% of children
with generalized atopic dermatitis develop asthma and allergic rhinitis by age
13 years.
Copyright © 2011 by Saunders an imprint of Elsevier Inc. All rights reserved.