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1、Atopic dermatitis特应性皮炎特应性皮炎DefinitionAD is commonly associated with xerosis and a susceptibility to irritants and protein allergies, as well as an atopic diathesis, i.e. the tendency to develop asthma, allergic rhinitis and possibly IgE-mediated systemic manifestations.Atopic dermatitisAtopic dermat
2、itis (AD) is a common skin disease worldwide that may occur at any age, but usually arises before the age of 5 years. Typically, there are three stages: infantile, childhood and adulthood. Acute inflammation with exudation occurs commonly in the infantile form and there is a predilection for facial
3、and extensor involvement. Chronic inflammation with lichenification and scale increases in prevalence with age and it tends to localize to flexural regions. Synonyms: IgE dermatitis, eczema, atopic eczemaEtiologyEliciting Factors: Inhalants, specific aeroallergens, microbial agents, exotoxins of Sta
4、phylococcus aureus, foods (eggs, milk, peanuts, soybeans, fish, wheat and et al) Autoallergens: The human protein was able to induce in vitro T-cell reactivity and eczematous reactions in sensitized patients. Incidence/prevalenceAge of Onset: First 2 months and by the first years in 60% of patients.
5、Gender: Slightly more common in males than females.Prevalence: Between 7 and 15%.Genetic Aspects: The prevalence in children was higher (81%) when both parents had AD.EtiologyGenetics: Several genes coding for immune response, skin dryness, and the ability to deal with Staphylococcus aureus may be i
6、mportant;Environment: “Hygiene hypothesis”- children in larger families were protected from expressing atopy because of frequent exposure to infections;Immunologic abnormalities: Elevated serum immunoglobulin E (IgE) levels, reduced cell-mediated immune responses, and chemotaxis of neutrophils and m
7、onocytes. Clinical features Acute: Poorly defined erythematous patches, papules, and plaques with or without scale;Edema with widespread involvement; Skin appears puffy and edematous.Clinical features Subacute and chronic: Lichenification ：thickening of the skin with accentuation of skin markings; F
8、issures: in flexures, on palms, fingers, and soles; Pigmentation: as a result of compulsively rubbing. Erythematous lichenification with accentuation of skin markings in the antecubital fossa of a 9-year-old girl. These lesions are extremely pruritic. A typical localization of atopic dermatitis in c
9、hildren is the region around the mouth. In this child there is lichenification and fissuring. Generalized eruption of follicular papules that are more heavily pigmented than normal skin in a 53-year-old woman of African extraction. Diagnosis The diagnostic criteria for AD are based primarily on clin
10、ical manifestations and the exclusion of other disease entities. History in infancy.Clinical findings (typical distribution sites, morphology of lesions).Elevated level of serum IgE (85%).A personal or family history of AD, allergic rhinitis, and asthma.DiagnosisDifferential Diagnosis Seborrheic der
11、matitisContact dermatitisPsoriasisNummular eczemaDermatophytosisEarly stages of mycosis fungoidesTreatment1.General management : in ordder to alleviate the clinical symptom, trigger factors should be avoided;2.Baseline therapy of dryness with emollients; 3.Systemic therapy: Oral H1 antihistamines ar
12、e useful in reducing itching; 4.Topical therapy: Topical anti-inflammatory agents such as glucocorticoids, new-nonsteroidal anti-inflammatory agents, such as topical tacrolimus and pimecrolimus;5. UV：UVA-UVB phototherapy, narrow band UVB (311 nm), PUVA Acute inflammation Erythema, papule, papulovesiclevesile, bulla, erosion, oozing Powders, lotions, wet dressings , wet dressings, oil Subacute inflammationErythema, scaling, a little erosion scalling, drynessPaste,oil cream, gelChronic inflammationLichenification only pruritusPlaster, ointment, cream, spirit, lotions, creamThanks！
