Fast Five Quiz: Atopic Dermatitis

Richard P. Vinson, MD


February 11, 2020

Figure 1. Atopic dermatitis

The progression of allergic diseases, beginning with AD, is referred to as "atopic march" or "allergic march." Atopic march occurs when patients develop multiple allergic conditions as they age and may include atopic dermatitis, food allergies, allergic rhinitis, and asthma. AD is usually the first condition in the atopic march, with incessant pruritus as the primary symptom. The disease often presents in infancy and will wax and wane throughout the patient's lifetime. About one third of patients with atopic dermatitis will develop asthma. and about one third will develop allergic rhinitis. Primary findings of AD include xerosis, lichenification, and eczematous lesions.

Seborrheic dermatitis (SD) is not included in the progression of allergic diseases, but may be confused with AD in infancy. Although both AD and SD may present with cradle cap on the scalp, the scaling associated with AD tends to be dry and crusty as opposed to the yellow, greasy scales typical of SD.

Lichenification, or thickened areas of skin, is a symptom of chronic AD and develops as a result of long-term rubbing of the skin, typically over skin folds, bony prominences, and the forehead. It usually does not occur in infants.

Contact dermatitis is not included in the progression of allergic diseases and is an exclusionary condition of AD. Contact, or irritant, dermatitis results from exposure to a skin irritant and will resolve upon discontinuation of the exposure. Although patients with AD are at increased risk of developing nonspecific hand dermatitis or irritant contact dermatitis, they are at a lower risk of having an allergic contact dermatitis to poison ivy.

Learn more about the progression of AD.


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