Atopic dermatitis is characterized by superficial skin inflammation and intense itching. Although atopic dermatitis may appear at any age, it typically begins during infancy or early childhood. It may then subside spontaneously, followed by exacerbations in late childhood, adolescence, or early adulthood. Atopic dermatitis affects less than 1% of the population.
Atopic dermatitis is a chronic, inherited skin disorder in which the immune system produces a hypersensitivity reaction to environmental allergens that are often difficult to identify.
Exacerbating factors of atopic dermatitis include irritants, infections (commonly caused by Staphylococcus aureus), and some allergens. Although no reliable link exists between atopic dermatitis and exposure to inhalant allergens (such as house dust and animal dander), exposure to food allergens (such as soybeans, fish, or nuts) may coincide with flare-ups of atopic dermatitis.
Scratching the skin causes vasoconstriction and intensifies pruritus, resulting in erythematous and weeping lesions. Eventually, the lesions become scaly and lichenous. Usually, they’re located in areas of flexion and extension, such as the neck, antecubital fossa, popliteal folds, and the backs of the ears. Patients with atopic dermatitis are prone to unusually severe viral infections, bacterial and fungal skin infections, ocular complications, and allergic contact dermatitis.
Typically, the patient has a history of atopy, such as allergic rhinitis asthma, or urticaria; family members may have a similar history. Laboratory tests reveal eosinophilia and elevated serum immunoglobulin E levels.
Measures to ease this chronic disorder include meticulous skin care, environmental control of offending allergens, and drug therapy.
CLINICAL TIP: Because dry skin aggravates itching, frequent application of nonirritating topical lubricants is important, especially after bathing or showering. Minimizing exposure to allergens and irritants, such as wools and harsh detergents, also helps control symptoms.
Drug therapy includes a corticosteroid and an antipruritic. Active dermatitis responds well to a topical corticosteroid, such as fluocinolone acetonide and flurandrenolide; however, the drug should be applied immediately after bathing for optimal penetration. An oral antihistamine, especially a phenothiazine derivative such as methdilazine and trimeprazine, can help control itching. A bedtime dose of an antihistamine may reduce involuntary scratching during sleep. If a secondary infection develops, an antibiotic is necessary.
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Copyright Details: Handbook of Diseases, Copyright © 2008 Williams & Wilkins.
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Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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