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Last Updated: 12/11/2014  

Atopic Dermatitis

Atopic dermatitis (also called atopic eczema) is a chronic inflammatory disease that commonly presents in infancy or early childhood (although it can persist into adulthood or begin in adults) and is familial.

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).

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.
Authors and Disclosures:
Robert Sidbury, MD was a speaker for Novartis, received honorarium from Novartis, received grants. Pablo Fernández Peñas, MD, PhD, FACD received honoraria from Janssen, Galderma, Abbvie, and Roche; served as a consultant for Abbvie, Roche, Meda, Novartis, Galderma, Janssen, and Celgene.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD; Richard Lynn, MD, FACP.

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