Master Atopic Dermatitis with a Mnemonic

Patients classically present with a pruritic and erythematous vesicular rash. These vesicles may ooze when scratched and crust over when they heal.

Atopic dermatitis, also known as eczema, is a chronic inflammatory skin rash. The rash occurs in a relapsing and remitting pattern.

In infants to children 2 years old, the most commonly involved areas are the cheeks and extensor surfaces.

In children older than 2 years old and adults, the most commonly involved areas are the flexural areas (e.g. neck, antecubital fossae and popliteal fossae).

Atopy is a predisposition towards developing certain allergic hypersensitivity reactions such as eczema, allergic rhinitis (hay fever) and asthma. Therefore, a history of atopic dermatitis is a strong risk factor for the development of asthma or allergic rhinitis.

Tacrolimus is available as a topical ointment for the treatment of atopic dermatitis. Tacrolimus is a nonsteroidal immunomodulating agent that works locally to suppress the release of inflammatory mediators via calcineurin inhibition. Unlike topical corticosteroids, tacrolimus does not cause skin atrophy, so it is often used in thin-skinned areas such as the face. However, these agents are used with caution due to a possible link between tacrolimus and lymphoma.

Skin hydrating moisturizers are an important component of atopic dermatitis treatment. The use of moisturizers serves to hydrate the stratum corneum and maintain the lipid barrier. It is recommended that patients apply moisturizers immediately after bathing in order to maintain proper skin hydration.

Topical corticosteroids are used to suppress cutaneous inflammation in mild to moderate atopic dermatitis. For severe atopic dermatitis in adolescents or adults, especially during acute flares, systemic corticosteroids may be used.

In adolescents and adults with moderate to severe atopic dermatitis, phototherapy treatment may be implemented if topical therapy has failed.

Avoiding triggers is key to the management of atopic dermatitis. Common triggers include low humidity, dry skin, excessive heat, exposure to detergents or irritants, dust mites, animal dander and UV light.

Oral and topical antihistamines are used to provide symptomatic relief of pruritus and break the itch-scratch-itch cycle.