The onset of atopic dermatitis can be seen in infants who have a family history of inhalant allergies, (eg, seasonal allergy, allergic rhinitis, or allergy-induced asthma). The cheeks and large flexural folds of affected children are erythematous and scaly. Involved areas of the trunk and extremities may exhibit discrete patches or a generalized rash.
The cause has not been proved; one possibility is an altered immune response to a variety of antigenic stimuli. Patch or scratch testing typically is not elucidating.
Fewer than 5% of atopic patients have food allergies, which generally produce pruritus within hours of ingestion of the allergen.
Control of the patient's environment may help relieve pruritus. Patients often complain that itching is exacerbated by excessive heat and humidity and/or cold and dry conditions. Recommend the use of a humidifier and skin moisturizers, particularly during the winter. In the summer, suggest that the patient avoid midday outdoor activities and opt instead to enjoy air-conditioned environments.
Atopic patients are at increased risk for bacterial (staphylococcal), fungal (candidal), and viral (herpes simplex) infections. Monitor patients carefully; culture eruptions and treat persons who have flares of their disease or painful lesions.
Topical corticosteroids are the primary therapeutic agents in atopic dermatitis. Systemic antihistamines are not effective. In the pediatric population, it is essential to use the least potent corticosteroid that maintains remission. Prescribe nonhalogenated corticosteroids for prepubescent patients; use stronger agents only for flares or for no longer than 2 weeks before returning to the lower-strength preparations.
The good news: most patients outgrow this condition by their teenage years.