Atopic dermatitis — Clinical Case (Wikimedia Commons)

Diagnosis: Atopic dermatitis

dermatite atopica. Clinical photograph sourced from Wikimedia Commons (CC BY-SA 3.0). Attribution: User:Assianir.

Clinical Presentation

Infantile: face, scalp, extensor surfaces. Childhood: flexural (antecubital, popliteal fossae). Adult: hands, eyelids, flexural areas. Features: erythema, xerosis, pruritus, excoriation, lichenification. Dennie-Morgan folds, pallor, keratosis pilaris may be present.

Clinical History

Personal/family history of atopy (eczema, asthma, allergic rhinitis). Pruritus is the hallmark — 'the itch that rashes.' Triggers: irritants, allergens, stress, infection, climate changes. Sleep disruption common. Assess SCORAD or EASI for severity.

Treatment

Stepwise approach: emollients (foundation), topical corticosteroids (flares), calcineurin inhibitors (maintenance/sensitive areas), crisaborole (PDE4 inhibitor). Moderate-severe: dupilumab (IL-4/13 blocker), JAK inhibitors (upadacitinib, abrocitinib), tralokinumab. Phototherapy for widespread disease.

Differential Diagnosis

Seborrheic dermatitis, Contact dermatitis, Psoriasis, Scabies, Dermatophytosis, Cutaneous T-cell lymphoma, Netherton syndrome

Key Learnings

Dupilumab has transformed management of moderate-severe AD in adults and children ≥6 months. Proactive maintenance therapy (twice-weekly topical steroids to previously affected areas) reduces flare frequency. Screen for comorbidities: food allergies, asthma, ADHD, depression.

Tags: atopic dermatitis, eczema, atopic, inflammatory, pruritic, chronic