AD often presents at an early age and follows a classic distribution. When there is no itch, and odd distribution, rethink the diagnosis.
Patients with eczema have an increased risk of ADHD, depression, anxiety, sleep deprivation. Even when they do sleep, sleep is less restful in kids with Atopic Dermatitis - leads to impaired growth. Swanson: Always do ointments in little kids - better adherence to skin.
Olive oil worsens atopic dermatitis and should be avoided.
Calcineuren inhibitors highly effective in children - pimecrolimus safety study over 2400 patients show safety of long term use and no lymphoma or other malignancy signals.
Dupilumab is indicated for patients with moderate to severe atopic dermatitis in patients aged 12 and up. Dupilumab is dosed based on weight in the adolescent age group. Swanson: Itch improved faster with dupilumab than skin clearance.
Eye symptoms the most common side effect of dupilumab - conjunctivitis, blepharitis and eye pruritus. Common enough you need to warn people.
For now there is a warning to avoid live vaccines while on Dupixent.
Atopic dermatitis maintenance (click to enlarge the image).
Contact dermatitis is more common in people with a background history of atopic dermatitis. Allergic contact dermatitis (ACD) tends to be more severe than irritant dermatitis.
Nickel is the most common contact allergen. Rash on the lower abdomen or earlobe. Dimethylglyoxime test can determine if something contains nickel. ID reaction - common complication of nickel allergy.
Wet wipe dermatitis now 2nd in line for common causes of allergic contact dermatitis.
Toilet seat dermatitis - due due to cleaner or a chemical in the toilet seat itself. Treat with soft seat liner.
Every ingredient in kids slime is an irritant - borax, glue and soap. Slime dermatitis now very common in kids.
Guttate psoriasis is the most common type of psoriasis in children. Guttate = tear drops. Swanson: Psoriasis loves the belly button. To the point where you see a rash affecting the belly button its psoriasis until proven otherwise. Palmoplantar psoriasis - very well demarcated.
Seborrheic dermatitis - associated with going to bed with wet hair or incomplete shampooing.
Swanson: Perioral dermatitis can look like eczema or acne - common with steroid nebulizers or is otherwise idiopathic. Responds to elidel/tacrolimus. One month or oral antibiotics works 100% of the time.
Asymmetrical facial rash in a child is a fungal infection until proven otherwise. Tinea corporis can be managed with topical antifungals but scalp involvement needs systemic therapy.
Pustules on the hands and feet of a baby - think scabies.
Mycosis fungoides - persistent eczematous or tinea- like rash. Needs a biopsy to diagnose.
Mary McHenry MD @maryjmchenry: Update on biologic agents: side effects important to know about including infusion reactions, Type 1 IgE reactions, cytokine reactions, and Type IV delayed reactions.
Many considerations for starting a biologic in atopic patient: Impact on infections, risk in environments with high parasite infestation, lack of data in children and pregnant women, BUT so far safety data is encouraging. Exciting times in allergy!
Dr. Ellis @DrAnneEllis: Hypersensitivity reactions to biologics are, in general, actually rare.
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