Atopic dermatitis, the most common type of eczema, is a chronic itchy skin disease caused by a weak skin barrier and an overactive immune response. It usually starts in childhood, comes in flares and often occurs with asthma and allergic rhinitis.
Key symptoms
- Intense itch, often worse at night
- Dry, rough skin
- Red, scaly patches that come and go in flares
- Oozing or crusting during bad flares
- Personal or family history of asthma, hay fever or food allergy
What you find on exam
- Infants: face, scalp and the outer arms and legs
- Older children and adults: skin creases such as the inner elbows and behind the knees
- Scratch marks and thickened skin with deep lines (lichenification)
- Honey-colored crusts or punched-out erosions suggest infection
Tests
- Clinical diagnosis based on history and exam
- Bacterial culture if infection is suspected; viral PCR for punched-out sores
- Patch testing if a contact allergy is suspected
- Allergy tests only when the history points to a specific food trigger
Treatment basics
- Daily thick emollients and short lukewarm baths with gentle soap-free cleansers
- Topical corticosteroids for flares, matched in strength to site and severity
- Topical calcineurin inhibitors such as tacrolimus for the face and skin folds
- Moderate to severe disease: dupilumab, phototherapy or other systemic therapy
- Avoid triggers: harsh soaps, wool, heat and sweating
Red flags
- Clustered, painful punched-out sores with fever (eczema herpeticum)
- Spreading honey-colored crusts, pus or fever
- Red, inflamed skin covering most of the body
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.