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Last Updated: 7/31/2014  

Atopic Dermatitis

Diagnosis
  • Ask the patient or parent about:

    • Pruritus and dermatitis involving the skin creases

    • Season variation and exacerbation with certain foods, wool, soaps and detergents, and stress

    • History of contact dermatitis

  • Look for erythema, papulation, excoriation, and lichenification on flexural areas.

  • Obtain a 4-mm punch biopsy from an active lesion if the diagnosis is unclear.

Hospitalization
  • Hospitalize patients with acute decompensation of atopic dermatitis involving more than 80% of the body surface area (erythroderma).

  • Hospitalize most patients with atopic eczema and disseminated herpes virus infection for antiviral therapy and skin care.

Therapy
  • Recommend regular use of emollients.

  • Recommend dust mite or other allergen reduction to reduce symptoms in sensitized individuals.

  • Use topical steroid therapy as first-line treatment in all patients with atopic dermatitis not responding to emollients and the avoidance of triggers.

  • Offer topical calcineurin inhibitors (tacrolimus or pimecrolimus) as second-line agents in certain patients.

  • Offer phototherapy in adult patients with widespread atopic dermatitis in whom topical therapy has failed.

  • Treat recalcitrant pruritus in adults with topical doxepin 5% cream.

  • Offer sedating antihistamines to patients who lose sleep due to chronic nighttime itching and nonsedating agents during the daytime for concurrent allergic rhinitis or conjunctivitis.

  • Prescribe a topical antibiotic (mupirocin 2%) at the first sign of localized bacterial superinfection.

  • Treat patient with widespread signs of cutaneous infection with systemic antibiotics such as cephalosporins.

DOI: 10.7326/d922
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Robert Sidbury, MD was a speaker for Novartis, received honorarium from Novartis, received grants. Pablo Fernández Peñas, MD, PhD, FACD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, Editor.
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