Presentation

Lots of variability in how it presents, nummular, extensor, flexor ... this varies by age as well skin tone also changes appearance

Other findings:

• Follicular prominence (looks like they have goosebumps)
• Post inflammatory pigmentary change (hypopigmentation)
• Hyper-linear palms, especially more noticeable in kids > adults

infected?

weepy look toxins with superanigen effect with atph bc it's up to 90% of skin lesions use bleach baths + antibiotics

Pathophysiology

Normal skin: blocks irritants and allergens Mild AD: barrier changes, irritants and allergens make their way into the skin Flaring: Staph colonization, worsened barrier, loss of water Many of those barrier changes are relevant to the immune system... it's overactive Natures reviews 2022 has a good review article on this

For patients: 1) barrier disruption 2) immune system dysregulation

Why care

Chronic relapsing, frustrating, sleep deprivation, financial burden ... Plus they get advice unsolicited from every single person ...

Epidemiology

Atopic conditions obviously Also depression Also autoimmunity

Differential diagnosis

• Scabies
• Contact dermatitis
• Ichthyoisis
• sebhorric derm
• psoriastic

Atopic dermatitis and food allergies

Very commonly held perception ... Food allergies do NOT cause AD AD might increase risk of food allergies May be some flares of AD with some foods...? but this is not the typical IgE pathyway VERY VERY rarely has derm ever seen removal of a food help with it

Management

See 2019 Journal of cutaneous medicine and surgery: atopic dermatitis mild to mod There's a great flowchart

1. Fix protective function with moisturizer - thicker, at least creams avoid contact with triggers - no bubble baths, fragrance, no dryer sheets Rinse after swimming

2. Use medicine to calm the immune ystem BID during flare until compeltel clear BID to recurrent areas as part of amintenance Topical steroids, calcineurin inhib, PDE4 inhib

Ezecma care plan Eczema society of canada has one

Treatments

Some definitions:

• FTU: Fingertip unit - strip / line, enough to cover two palms worth
• Size of container matters. Ie. 250g tubs for hydrocort, or 150-200 for betamethasone. ie. a 50g tub if hydrcort should last <1 week if using the correct amount

Topical steroids

Hydrocort can go ANYWHERE Betaderm not for face but rest of body ok Mometasone ok for body clobetasol very potent, limited areas only, thick skin only, no face

You can mix and match stronger steroids with the nydrcort ... ie if there is hetergencity in severity in distrub

Alcohol analogy Different alcohols have different strength long term use blah clobetasol is your vodka mometasone/betamethason: beer/wine, use for a few weeks, probably not every day for months and months Hortcort - like kombucha, use whatever whenerver

OD vs BID vs PRN

Topical non steroids

• Calcineruin inhibiotrrs (tacro, pimecrolimus)
• PDE4 inhbiotrs (crisborole, romflumilast)
• JAKi (ruxolinib) - selective JAK1 JAK2 inhibiotr
• Aryl hydrocarbon receptor modulating agent (tapinarof not yet available)

ithcing dealing with

• AH not thattt helpful, cause not histmaine really
• keeping them cool at night bc hot can increase itch
• exposed skin tends to be scratched more - long sleeves long pants
• for teenagers, artifical nails sometimes

Biologics / systemic therapy

NBUVB first Then MTX CsA MMF or AZA immune modulators PRednisone ONLY as a rescue do not use if possible biologics / Jaki

Funding is kinda wack province to province

dupi - very well toelrated... but 5% conjunctivits, 12% skin infections vs 24% placebo, no routine blood monitoring ... vaccinations ok on it too updacitivb

ubccpd.ca/course/pediatric-atopic-dermatitis