Atopy .

practical approach .

atopy is not only a atopic dermatities ..it includes series of illness or from t
oo many criterias atleast 2 major or 3 minor criterias .

where we dont do any test , we should advice test to check out wheather it is at
poy or not as it tells us about the prognosis of the illness and how much treata
ble that disease is .

Diagnostic criteria

1.For the Child ¦Pityriasis alba

¦Nummular eczema
¦Periorbital dermatosis
¦Dermatitis of the hands

2.For the Adult ¦Head and neck dermatitis

¦Severe atopic eczema
¦Contact eczema is a frequent complication of atopic dermatitis in the adult (See
example).
¦Dermatitis of the hands

3.
The criteria of Hanifin and Rajka
AD diagnosis requires the presence of at least three of these criteria : ¦Major cr
iteria ¦Characteristic distribution
¦An essential sign : pruritus
¦Chronic progression with recurrences
¦
Familial history of atopy :
In 70 % of cases, evidence of eczema, asthma or seasonal rhinitis is found among
the direct ascendents of patients.
¦
Cutaneous minor criteria
¦Signs of skin dryness : hyperstriated palm, keratosis pilaris, xerosis
¦Facial pallor, pityriasis alba
¦Nipple eczema
¦Infections tendency, wool intolerance, pruritus caused by sudation
¦Extra cutaneous minor criteria ¦Ophtalmologic manifestations : Periorbital rings, r
ecurrent conjunctivitis, keratoconus / cataract
¦Other symptoms : Food intolerance, hyper IgE, course influenced by emotional or e
nvironmental factors
¦In practice : the six most useful diagnostic criteria for AD [WILLIAMS 1994] : ¦His
tory of flexural dermatitis
¦Onset under the age of two years
¦Presence of an itchy rash
¦Personal history of asthma
¦History of a dry skin
¦Visible flexural dermatities ..... and serum IGE is a must test which we should
advice . IT is not a test for prognosis as it keeps on chnaging according to st
ate of patients hence what we yearn for ....is better ment of the symptoms . mor
e patinet is symptomatic better and more less is the serum IgE,
¦...............................STILL MORE TO BE CONTINUED .

.............................always look for ...or there is always bacterial gro

wth on the ...lesions of atopic dermatioes which is active .

Best treatment is ......MOSITURZING AND ......ADVICED NOT TO TAKE BATH FOR LONG
IN WATER OR AVOID SWIMMING.......and whenever temperature chnages or pullution a
nd dust is there .....there is more itching and lesions .

Differential diagnostic

1.Facial dermatosis ¦Seborrheic dermatitis

¦Langerhans histiocytosis
¦Localized herpetic infection
Although sometimes considered as impetigo vulgaris or a flare-up of eczema, umbi
lication of the vesicles should suggest the correct diagnosis.

2.Pruriginous dermatosis ¦
Scabies
Knowing how to search for characteristic burrows. Palmoplantar vesiculopustules
are frequent in the newborn.
¦
Prurigo strophulus
Papules, with a rapidly excoriated pruriginous vesicle, located on exposed parts
.

3.
Extensive forms of dermatosis
¦Bipolar dermatitis
¦Psoriasis
¦Erythrodermic psoriasis
¦Langerhans cell histiocytosis
¦Diaper dermatitis

SERUM IgE POSITIVE IN

DARK CIRCLES . ---

DIRTY NECK APPEARANCE IN ATOPICS ...
pEOPLE having recuurent ...folliculites and furncles ...go for serum IgE.