Atopic Dermatitis

P. BALAMIENTO, MD
OBJECTIVES

 Present a case of atopic dermatitis in an infant

 Discuss the differential diagnoses of atopic dermatitis with their key differences
 Discuss the pathophysiology of atopic dermatitis
 Discuss the diagnostic and therapeutic management of atopic dermatitis
Cc: rash x 12 days

10-month-old female
From Caloocan
Carried in by mother, good reliability
 HISTORY OF PRESENT ILLNESS

9 days 4 days

gradually increased in number then Given cetirizine by BHW at unrecalled dose

coalesce back of upper arms, extensor at health center, father tried applying
surface of thighs clotrimazole to lesions once a day

11 days prior 5 days On the day

Red raised lesions starting on Development of scaling, wet No improvement in lesions, thus
cheeks and some on the scalp; erosions and excoriations in the sought consult at NCH
Baby appears to become irritable affected area with increase in
and scratches at affected areas more coverage of red, raised skin
often at night
HPI

 No fever
 No cough/coryza, no cardiorespiratory distress
 No loss of appetite
 Review of Systems
General No fever, no weight loss Cardiovascular No cyanosis or distress

Skin
Usually dry GI
No vomiting or diarrhea

HEENT No trauma; no apparent problems hearing or GU No hematuria, no genital lesions

seeing; no runny nose
Musckoloskeletal No active dermatoses
Neck No mass Hematologic/Endocrine No weight loss or unusual weight gain; no bleeding
Neurologic No seizure, no head trauma, no fainting
Respiratory No cough, no distress, no cyanosis
Birth/Maternal Hx

 Born at 38 weeks AOG to a 29y/o G2P2 (3003) via spontaneous

vaginal delivery at a lying in clinic. No cord coil, meconium staining,
jaundice or sign of distress at birth. Newborn screening negative;
hearing screening not done. Vitamin K, BCG, Hep B1 given.
Birth/Maternal Hx

 at 2 mos AOG noted to have missed menses. PNCU started at 3 mos

AOG, >5x, carried out by midwife; Labs done including cbc and
urinalysis; claimed to be normal. Ultrasound done 2x no noted
abnormality; Noted to have cough at 10mos AOG, no medications
given, no fever. Spontaneously resolved.
Past Medical History

No prior hospitalization, accident, or surgery

FAMILY HISTORY

 Maternal side – asthma; Hypertension; Paternal side – diabetes

mellitus
IMMUNIZATION HISTORY

No BCG or Hep B

 1 - BCG
 3 – DPT, HepB, Hib, OPV
 1 – IPV
 3 – PCV
 1 - measles
 PHYSICAL EXAMINATION

General awake, alert, cheerful demeanor

HR 112 rr 31 temp 36.7 Sats 99%

Vital Signs
Weight: 8 kg (z=0)
Anthropometrics length 74cm (z=0
HC 45 (z=0)
CC 47
AC 48
Appropriate for gestational age

Erythematous confluent papules and plaques, with weeping erosions with minimal crusting, excoriations, with
Skin occasional scales on cheeks, scalp,
Head: normocephalic, flat fontanels
HEENT Eyes: pink palpebral conjunctivae, anicteric sclerae
Ears: no ear discharge
Nose: non-congested turbinates
Throat: no cleft lip or palate; moist lips, non-hyperemic posterior pharyngeal wall,
 PHYSICAL EXAMINATION
Neck Supple neck, no lymphadenopathy

Lungs
symmetric chest expansion
no retraction, clear breath sounds
Heart Adynamic precordium, regular rhythm, distinct S1 and S2, no murmurs

Gastrointestinal/Genitourinary
No diarrhea/no vomiting

Extremities Full equal pulses, CRT <2 seconds, no edema, warm extremities
Differential Diagnosis

 Seborrheic dermatitis – usually more crusting, scaling, not very

pruritic; facial groove; also involves chest and intertriginous areas
 Viral exanthems – no fever
 Scabies – no involvement of family members
 Impetigo – no predominance of crusts,
Pathophysiology

 Born at 38 weeks AOG to a 29y/o G2P2 (3003) via spontaneous

vaginal delivery at a lying in clinic. No cord coil, meconium staining,
jaundice or sign of distress at birth. Newborn screening negative;
hearing screening not done. Vitamin K, BCG, Hep B1 given.