دکتر افشین شیرکانی فوق تخصص آسم و آلرژی و بیماری های نقص ایمنی عضو آکادمی آسم و آلرژی و ایمونولوژی آمریکا استادیار دانشگاه
MAJOR FEATURES : Pruritus (the most important) Facial and extensor eczema in infants and children Flexural eczema in adolescents Chronic or relapsing dermatitis Personal or family history of atopic disease
>10% of infants 90% onset before age 5 Atopic march: >50% of patient develop asthma or other allergy
Genetics(fillaggrine mutation),Environment: Skin barrier damage IgE to Staphylococcus aureus toxins, Superantigen stimulation causes Treg lose suppressive activity A decrease or absence of antimicrobial peptides Acute: IL-4, IL-13 Chronic: IL-5, IL-12, IFN-γ
1.Older children and adults have lichenification of flexor surfaces including: Hands Feet Face Antecubital and popliteal fossa 2.Infants have involvement of: Extensors Neck Trunk Face Spares nasolabial skin fold
Skin biopsy can be useful in patients who do not respond well to corticosteroids Patch testing is useful in patients with suspected contact allergen such as nickel or cosmetics SPT for identifying aeroallergen triggers such as: Dust mites Animal dander Weeds Molds
Patch tests
Staphylococcus aureus herpesKaposi(varicelliform eruption or eczema herpeticum ) molluscum contagiosum, papillomavirus (warts) Malassezia furfur, and Pityrosporum ovale. Eczema Vaccinatum (smallpox vaccination) Anterior cataracts are associated with Atopic keratoconjunctivitis. Posterior cataracts are associated with Prednisone
Food (milk, egg, soy, wheat, fish, peanuts, and tree nuts) Aeroallergens( Dust mites, Animal dander, Weeds, Molds) Autoantigens Microbial Agents and Toxins
Cutaneous hydration and emollients Topical corticosteroids: Topical calcineurin inhibitors Avoidance of triggers of AD Antihistamines to control itching. Novel treatments include Vitamin D Immunotherapy for aeroallergen