A nine-year-old girl instants with ...

A nine-year-old girl instants with a three-month history of unrelenting persistent itching and skin lesions everywhere most of her body. Physical examination revealed numerous 15 to 20 mm papulonodular lesions through all the extremities and bole with some confluence (see accompanying figure). Crusting and lichenification also were observ No lesions were not absent on the face.

Question

Based forward the patient's history and physical examination, which common of the following is the in the greatest degree likely diagnosis?

[] A. Psoriasis vulgaris. [] B Pemphigus vulgaris. [] C strict atopic dermatitis. [] D. Lichen planus. [] E Sweet's syndrome

Discussion

The answer is C: harsh atopic dermatitis. Atopic dermatitis is a form of endogenous dermatitis resulting in pruritic inflammation of the epidermis and dermis, which commonly befalls in infants and children on the other hand can be found in adults. Atopic dermatitis affects more than 10 percent of children, and the majority of patients are affected during the first five years of life. (1)

Psoriasis is an inflammatory epidermal proliferative disorder of the skin, which is usually not intensely pruritic. The in the greatest degree common lesions are papules and nodules like those shown in the photograph, still in psoriasis they are sharply demarcated and veiled by silvery white scale. The lesions most numerous commonly involve areas of the material substance that experience repeated minor trauma, of that kind as elbows, knees, scalp, feet and hands. Associated findings may include fingernail pitting or thickening (50 percent of cases) and arthritis (up to 10 percent of cases).

Pemphigus vulgaris is an autoimmune bullous disease of the skin that usually fall outs in adults and is rare in children. There is no pruritus. The lesions are flaccid vesicles or bullae that are initially localized in oral mucosa and later spread randomly to other parts of the visible form [i]or[/i] frame This can be a serious and potentially fatal disorder.

Lichen planus is characterized through flat-topped, polygonal, violaceous papules, which are a great deal of smaller than the confluent papulonodular lesions seen in methodical atopic dermatitis. The pruritus is variable. Lichen planus is out of the way in children. The common sites include wrists, shins, mucous membrane, lumbar area, and genitalia.

Sweet's syndrome is an strange disorder of the skin that generally has associated systemic symptoms like excitement arthralgias, and peripheral leukocytosis. The lesions are red-brown plaques and nodules athwart the head, neck, and upper extremities, which are painful rather than pruritic. Truncal lesions are rare and approximately 10 percent of patients have an associated underlying malignancy.

Atopic dermatitis is repeatedly accompanied by a personal or family history of asthma, allergic rhinitis, or allergic skin involvement. The storm of the skin lesions is usually subacute or chronic. In infants, the extensor surface of the extremities, face, and stalk are involved, whereas children and adults have predilection for the flexural areas of the extremities, neck and upper bole Patients with atopic dermatitis frequently have diffusely dry skin. Pruritic papules with vesicles are typical initially; these may become scaly and crusty later. Chronic lesions may have thickened lichenified skin with fibrotic papules and nodules as are seen in this case. The distribution of the lesions may become more diffuse in the chronic condition. Secondary infection is for the use of all especially with Staphylococcus aureus. (2)

Atopic dermatitis may be confused with a number of the eczematous dermatitides including contact dermatitis, seborrheic dermatitis, and psoriasis. In dark-skinned patients, it is repeatedly difficult to differentiate the lesions from the other conditions as outlined above because of the lack of contrast between the lesions and uninvolved skin. In blacks, a subtype of atopic dermatitis arises frequently where each papule involves a separate hair follicle, and is spelled follicular eczema.

The diagnosis of atopic dermatitis is based primarily forward clinical presentation and history. No laboratory standards are available to definitively establish a diagnosis of atopic dermatitis, although patients may have elevated flats of IgE and peripheral family eosinophilia. The histopathologic changes seen in biopsy specimens of atopic dermatitis are nonspecific.

general triggers of atopic dermatitis include dried skin, infection, physical or emotional stres sweating, and skin irritants. These irritants can include soaps, detersives cosmetics, wool and acrylic clothing, linens, and perfumes

Symptomatic treatment consists of the use of moisturizers to interrupt the itching caused by thirsty skin. Avoidance of any of the irritants or triggers is the cornerstone of therapy. Mild or no soap should be used when bathing. passionate baths or frequent bathing may cause drier skin and should be avoided. Oral antihistamines can help have charge of itching. Use of [H.sub.2] blocker in cases of chaste pruritus may be helpful. Topical steroid ointments or creams in addition to unruffled wet dressings are useful in acute flares of the disease as well as in maintenance of healing in the chronic phase. Topical or oral antibiotics should be considered when there is suspicion of secondary infection, because this may be a cause of persistent pruritus.