eMedicine Specialties > Ophthalmology > Dermatologic Disorders

Dermatitis, Atopic: Follow-up

Author: R Scott Lowery, MD, Assistant Professor of Ophthalmology, Department of Pediatric Ophthalmology and Strabismus, University of Arkansas for Medical Center, Arkansas Children's Hospital
Contributor Information and Disclosures

Updated: Apr 10, 2009

Follow-up

Further Outpatient Care

  • Prophylaxis against scratching should be taken.
    • Scratching the lesions can worsen them and lead to the lichenification process characteristic of long-standing disease.
    • Corneal abrasions and further eye irritation also may occur. Antihistamines, mast-cell stabilizers, and corticosteroids will aid in reducing the itching but may require some time to take effect.
    • Nails should be kept clean and trimmed.
    • In pediatric patients, mittens may be used at night or even daily, when possible, if itching and scratching are severe.

Deterrence/Prevention

  • Stress control, avoidance of allergens (most commonly dust mites, peanuts, egg, milk, fish, rice, soy, and wheat), and irritants (particularly chemicals, soaps, heat, humidity, wool, and acrylic) may help control the disease.

Complications

  • The use of corticosteroids is fraught with potential ocular and systemic complications. In particular, cataract formation, glaucoma development, and potential corneal thinning must all be considered when deciding to use steroids for this disease. Long-term use should be avoided if at all possible.

Prognosis

  • The prognosis is good if the inflammation can be kept under control with therapy. Patients need to understand that atopic disease cannot be cured, but rather controlled. However, some patients have such severe disease that treatment will not prevent vision loss and other potential complications.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Steroid use is probably the biggest area of concern in the treatment of ocular atopic dermatitis because of the complications that can result from steroid use. Corneal scarring and long-term vision loss can result, in addition to glaucoma and cataract development. The potential exists for corneal perforation and loss of an eye with, or even without, the use of steroids.
 


More on Dermatitis, Atopic

Overview: Dermatitis, Atopic
Differential Diagnoses & Workup: Dermatitis, Atopic
Treatment & Medication: Dermatitis, Atopic
Follow-up: Dermatitis, Atopic
References
Further Reading
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References

  1. Rapoza PA, Chandler JW. Atopic dermatitis. In: Weingeist T, Gould D, eds. The Eye in Systemic Disease. Philadelphia: Lippincott; 1990:606-609.

  2. Shen CP, Xing H, Ma L. [Research advances in atopic dermatitis]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Feb 2009;31(1):103-6. [Medline].

  3. Jung T, Stingl G. Atopic dermatitis: therapeutic concepts evolving from new pathophysiologic insights. J Allergy Clin Immunol. Dec 2008;122(6):1074-81. [Medline].

  4. Bezan DJ. Eye itch. In: Bezan DJ, Larussa FP, Nishimoto JH, et al, eds. Differential Diagnosis in Primary Eye Care. Boston: Butterworth-Heinemann; 1999:67-71.

  5. Brenninkmeijer EE, Legierse CM, Sillevis Smitt JH, Last BF, Grootenhuis MA, Bos JD. The course of life of patients with childhood atopic dermatitis. Pediatr Dermatol. Jan-Feb 2009;26(1):14-22. [Medline].

  6. Anderson PC, Dinulos JG. Atopic dermatitis and alternative management strategies. Curr Opin Pediatr. Feb 2009;21(1):131-8. [Medline].

  7. Ricci G, Dondi A, Patrizi A, Masi M. Systemic therapy of atopic dermatitis in children. Drugs. 2009;69(3):297-306. [Medline].

  8. Kaujalgi R, Handa S, Jain A, Kanwar AJ. Ocular abnormalities in atopic dermatitis in Indian patients. Indian J Dermatol Venereol Leprol. Mar-Apr 2009;75(2):148-51. [Medline].

  9. Clark RAF, Kristal L. Atopic dermatitis. In: Sams J, Lynch PJ, eds. Principles and Practice of Dermatology. 2nd ed. New York: Churchill Livingstone Inc; 1996:403-418.

  10. Friedlander MH. Diseases affecting the eye and the skin. In: Allergy and Immunology of the Eye. 2nd ed. 1993:75-106.

  11. Friedlander MH. Atopic dermatitis. In: Current Ocular Therapy. 5th ed. Philadelphia: WB Saunders Co; 2000:143-144.

  12. Furue M, Terao H, Moroi Y, et al. Dosage and adverse effects of topical tacrolimus and steroids in daily management of atopic dermatitis. J Dermatol. Apr 2004;31(4):277-83. [Medline].

  13. Guin JD. Eyelid dermatitis: experience in 203 cases. J Am Acad Dermatol. Nov 2002;47(5):755-65. [Medline].

  14. Hanifin JM. Atopic dermatitis: broadening the perspective. J Am Acad Dermatol. Jul 2004;51(1 Suppl):S23-4. [Medline].

  15. Kanski JJ. Disorders of the conjunctiva. In: Clinical Ophthalmology. 4th ed. Boston: Butterworth-Heinemann; 1999:69-71.

  16. Liesegang TJ. Atopic keratoconjunctivitis. In: Pepose JS, Holland GN, Wilhelmus KR, eds. Ocular Infection and Immunity. St. Louis: Mosby; 1996:376-390.

  17. Roy FH. Ocular Differential Diagnosis. 7th ed. Philadelphia: Williams & Wilkins; 2002.

  18. Shelley WB, Shelley EB. Atopic dermatitis. In: Advanced Dermatologic Diagnosis. Philadelphia: WB Saunders Co; 1992:285-291.

  19. Uchio E, Miyakawa K, Ikezawa Z, Ohno S. Systemic and local immunological features of atopic dermatitis patients with ocular complications. Br J Ophthalmol. Jan 1998;82(1):82-7. [Medline].

  20. Weisbecker CA, Fraunfelder FT, Rhee D. Physicians' Desk Reference for Ophthalmology. 28th ed. Oradell, NJ: Medical Economics Co; 2000.

  21. Zimmerman TJ, Kulkarni PS, Meredith TA. Steroids in ocular therapy, antibiotics and antifungals, antiallergic therapies. In: Zimmerman TJ, Kooner KS, Shariv M, Fechtner RD, eds. Textbook of Ocular Pharmacology. Philadelphia: Lippincott-Raven; 1997:61-74, 363-385, 609-633,683-701, 801-804.

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Keywords

atopic dermatitis, atopic eczema, Besnier prurigo, prurigo Besnier, Besnier's prurigo, atopy

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Contributor Information and Disclosures

Author

R Scott Lowery, MD, Assistant Professor of Ophthalmology, Department of Pediatric Ophthalmology and Strabismus, University of Arkansas for Medical Center, Arkansas Children's Hospital
R Scott Lowery, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Jack L Wilson, PhD, Distinguished Professor, Department of Anatomy and Neurobiology, University of Tennessee at Memphis
Jack L Wilson, PhD is a member of the following medical societies: American Association of Anatomists, American Association of Clinical Anatomists, and American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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