Atopic Dermatitis in Emergency Medicine Follow-up

  • Author: Jamie Alison Edelstein, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Apr 11, 2011
 

Further Inpatient Care

  • Few patients with atopic dermatitis will require hospitalization. Patients with cellulitis or severe secondary infection may require intravenous antibiotics and sedation.
Next

Further Outpatient Care

  • Atopic dermatitis is chronic and relapsing. The main goal of treatment is control of the disease, not a cure. Patient education about management of flare and recognition of superinfection is paramount.
Previous
Next

Inpatient & Outpatient Medications

  • Few patients with atopic dermatitis will require hospitalization. Patients with cellulitis or severe secondary infection may require intravenous antibiotics and sedation.
Previous
Next

Deterrence/Prevention

  • Breastfeeding has indisputable benefits in infant nutrition, but no strong evidence suggests a protective effect against the development of atopic dermatitis, even in children with a family positive history.[14]
  • The mainstay of treatment of atopic dermatitis is prevention of outbreaks. Patients should continue to take short showers/baths followed by immediate hydration of skin with emollients even during rash-free times. They should also continue to avoid any triggers that may exacerbate atopic dermatitis.
Previous
Next

Complications

  • Excoriations secondary to itch predispose to infection and can be recognized by the accumulation of serum, crust, and purulent material. Development of vesicle and/or pustules in patients with known atopic dermatitis should initiate a search for bacterial or viral superinfection; appropriate antibiotics or antivirals should be started immediately. Patients with atopic dermatitis are uniquely susceptible to herpes simplex, which may occasionally progress to a Kaposi’s varicelliform eruption; physicians and patients should be particularly vigilant for this condition. This rare complication is characterized by generalized involvement, systemic toxicity, and even death. In these cases, the patient should be treated with oral acyclovir and monitored closely. Topical corticosteroids and/or occlusive dressings are best, at least temporarily, discontinued.
  • Exfoliative erythroderma is another rare complication, occurring in less than 1% of patients with atopic dermatitis. Exfoliative erythroderma demonstrates a marked progression caused by widespread Staphylococcus aureus or herpes simplex superinfection and can be life threatening if it is complicated by high-output cardiac failure and heat loss.
  • Atrophy or striae occur if fluorinated corticosteroids are used on the face or in skin folds.
  • Systemic absorption of steroids may occur if large areas of skin are treated, particularly if high-potency medications and occlusion are combined.
Previous
Next

Prognosis

About 90% of patients with atopic dermatitis have spontaneous resolution by puberty.

Adults who continue to have atopic dermatitis usually have localized dermatitis (eg, chronic hand or foot dermatitis, eyelid dermatitis, lichen simplex chronicus).

Unfavorable prognostic factors for atopic dermatitis (in order of relative importance) include the following:

  • Persistent dry or itchy skin in adult life
  • Widespread dermatitis in childhood
  • Family history of atopic dermatitis
  • Associated bronchial asthma
  • Early age at onset
  • Female gender

The objective when treating a patient for atopic dermatitis is control of exacerbations, not elimination of the disease. Using the above treatment modalities, patients and their families can hope to minimize the frequency and severity of outbreaks.

Previous
Next

Patient Education

  • Given the chronic nature of atopic dermatitis and patients' concerns about appearance, emotional support and psychological counseling may be helpful. Physicians need to be sensitive to the needs of patients and their families.
Previous
 
Contributor Information and Disclosures
Author

Jamie Alison Edelstein, MD  Staff Physician, Department of Emergency Medicine, State University of New York, Kings County Hospital Center

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert M McNamara, MD, FAAEM  Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine

Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Wu Chang M. Journal Watch, Review of Atopic Dermatitis. Apr 2 2008;[Full Text].

  2. Laughter D, Istvan JA, Tofte SJ, Hanifin JM. The prevalence of atopic dermatitis in Oregon schoolchildren. J Am Acad Dermatol. Oct 2000;43(4):649-55. [Medline].

  3. Kay J, Gawkrodger DJ, Mortimer MJ, Jaron AG. The prevalence of childhood atopic eczema in a general population. J Am Acad Dermatol. Jan 1994;30(1):35-9. [Medline].

  4. Brenninkmeijer EE, Schram ME, Leeflang MM, Bos JD, Spuls PI. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol. Apr 2008;158(4):754-65. [Medline].

  5. Ruiz RG, Kemeny DM, Price JF. Higher risk of infantile atopic dermatitis from maternal atopy than from paternal atopy. Clin Exp Allergy. Aug 1992;22(8):762-6. [Medline].

  6. Sandilands A, Smith FJ, Irvine AD, McLean WH. Filaggrin's fuller figure: a glimpse into the genetic architecture of atopic dermatitis. J Invest Dermatol. Jun 2007;127(6):1282-4. [Medline].

  7. McGrath JA, Uitto J. The filaggrin story: novel insights into skin-barrier function and disease. Trends Mol Med. Jan 2008;14(1):20-7. [Medline].

  8. [Guideline] Leung DY, Nicklas RA, Li JT, Bernstein IL, et al. Disease management of atopic dermatitis: an updated practice parameter. Joint Task Force on Practice Parameters. Ann Allergy Asthma Immunol. Sep 2004;93(3 Suppl 2):S1-21. [Medline]. [Full Text].

  9. Klein PA, Clark RA. An evidence-based review of the efficacy of antihistamines in relieving pruritus in atopic dermatitis. Arch Dermatol. Dec 1999;135(12):1522-5. [Medline].

  10. Reitamo S, Allsopp R. Treatment with twice-weekly tacrolimus ointment in patients with moderate to severe atopic dermatitis: results from two randomized, multicentre, comparative studies. J Dermatolog Treat. Jan 2010;21(1):34-44. [Medline].

  11. Gerasimov SV, Vasjuta VV, Myhovych OO, Bondarchuk LI. Probiotic supplement reduces atopic dermatitis in preschool children: a randomized, double-blind, placebo-controlled, clinical trial. Am J Clin Dermatol. 2010;11(5):351-61. [Medline].

  12. Betsi GI, Papadavid E, Falagas ME. Probiotics for the treatment or prevention of atopic dermatitis: a review of the evidence from randomized controlled trials. Am J Clin Dermatol. 2008;9(2):93-103. [Medline].

  13. Michail SK, Stolfi A, Johnson T, Onady GM. Efficacy of probiotics in the treatment of pediatric atopic dermatitis: a meta-analysis of randomized controlled trials. Ann Allergy Asthma Immunol. Nov 2008;101(5):508-16. [Medline].

  14. Yang YW, Tsai CL, Lu CY. Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies. Br J Dermatol. Feb 23 2009;[Medline].

  15. Ben-Gashir MA, Seed PT, Hay RJ. Predictors of atopic dermatitis severity over time. J Am Acad Dermatol. Mar 2004;50(3):349-56. [Medline].

  16. Boehme SA, Franz-Bacon K, Chen EP, Sasik R, Sprague LJ, Ly TW, et al. A small molecule CRTH2 antagonist inhibits FITC-induced allergic cutaneous inflammation. Int Immunol. Jan 2009;21(1):81-93. [Medline].

  17. Chan LS. Atopic dermatitis in 2008. Curr Dir Autoimmun. 2008;10:76-118. [Medline].

  18. Cork MJ, Robinson DA, Vasilopoulos Y, Ferguson A, Moustafa M, MacGowan A. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol. Jul 2006;118(1):3-21; quiz 22-3. [Medline].

  19. Eichenfield LF, Hanifin JM, Luger TA, Stevens SR, Pride HB. Consensus conference on pediatric atopic dermatitis. J Am Acad Dermatol. Dec 2003;49(6):1088-95. [Medline].

  20. Flohr C, Pascoe D, Williams HC. Atopic dermatitis and the 'hygiene hypothesis': too clean to be true?. Br J Dermatol. Feb 2005;152(2):202-16. [Medline].

  21. Grimalt R, Mengeaud V, Cambazard F,. The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: a randomized controlled study. Dermatology. 2007;214(1):61-7. [Medline].

  22. Gupta J, Grube E, Ericksen MB, Stevenson MD, Lucky AW, Sheth AP. Intrinsically defective skin barrier function in children with atopic dermatitis correlates with disease severity. J Allergy Clin Immunol. Mar 2008;121(3):725-730.e2. [Medline].

  23. Habif. Clinical Dermatology. 4th ed. Mosby Inc; 2004.

  24. Habif TP. Clinical Dermatology: Fourth Edition, A Color Guide to Diagnosis and Therapy. 2004:105-128.

  25. Hanifin JM, Paller AS, Eichenfield L, et al. Efficacy and safety of tacrolimus ointment treatment for up to 4 years in patients with atopic dermatitis. J Am Acad Dermatol. Aug 2005;53(2 Suppl 2):S186-94. [Medline].

  26. Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess. 2000;4(37):1-191. [Medline].

  27. Kang K, Polster AM, Nedorost ST, et al. Atopic dermatitis. In: Bolognia JL, Jorizzo JL, Rapini RP, et al, eds. Dermatology. New York: Mosby; 2003:199.

  28. Lane JE, Cheyney JM, Lane TN, Kent DE, Cohen DJ. Treatment of recalcitrant atopic dermatitis with omalizumab. J Am Acad Dermatol. Jan 2006;54(1):68-72. [Medline].

  29. Larsen FS, Holm NV, Henningsen K. Atopic dermatitis. A genetic-epidemiologic study in a population-based twin sample. J Am Acad Dermatol. Sep 1986;15(3):487-94. [Medline].

  30. Loden M. The skin barrier and use of moisturizers in atopic dermatitis. Clin Dermatol. Mar-Apr 2003;21(2):145-57. [Medline].

  31. Mancini AJ, Kaulback K, Chamlin SL. The socioeconomic impact of atopic dermatitis in the United States: a systematic review. Pediatr Dermatol. Jan-Feb 2008;25(1):1-6. [Medline].

  32. Rhodes AR. Treatment of atopic dermatitis: old and new modalities. Clin Rev Allergy. Feb 1986;4(1):87-99. [Medline].

  33. Rudikoff D, Lebwohl M. Atopic dermatitis. Lancet. Jun 6 1998;351(9117):1715-21. [Medline].

  34. Sauer GC. Manual of Skin Diseases. Publishers: Lippincott Williams & Wilkins; 1991:77-84.

  35. Simpson EL, Hanifin JM. Atopic dermatitis. Med Clin North Am. Jan 2006;90(1):149-67, ix. [Medline].

  36. Trepka MJ, Heinrich J, Wichmann HE. The epidemiology of atopic diseases in Germany: an east-west comparison. Rev Environ Health. Jul-Sep 1996;11(3):119-31. [Medline].

  37. Williams H, Robertson C, Stewart A, Ait-Khaled N, Anabwani G, Anderson R. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol. Jan 1999;103(1 Pt 1):125-38. [Medline].

 
Previous
Next
 
Irritation around mouth of an infant with atopic dermatitis.
Typical atopic dermatitis on the face of an infant.
Flexural involvement in childhood atopic dermatitis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.