Fast Five Quiz: Common Rashes and Skin Irritations

William James, MD


November 19, 2021

Primary findings of atopic dermatitis include xerosis, lichenification, and eczematous lesions. Excoriations and crusting are common, and some patients exhibit prurigo nodularis?like lesions. The eczematous changes and its morphology are seen in different locations depending on the age of the patient.

Atopic dermatitis is usually noticed soon after birth. Xerosis occurs early and often involves the whole body, though the diaper area is usually spared. Lichenification is seldom seen in infancy.

Xerosis in childhood is often generalized. The skin is flaky and rough. Lichenification is characteristic of childhood atopic dermatitis. It signifies repeated rubbing of the skin and is seen mostly over the folds, bony protuberances, and forehead. Lesions are eczematous and exudative. Pallor of the face is common; erythema and scaling occur around the eyes. Dennie-Morgan folds (ie, increased folds below the eye) are often seen. Flexural creases (the antecubital and popliteal fossae in particular) and buttock-thigh creases are often affected.

In adults with atopic dermatitis, lesions become more diffuse with an underlying background of erythema. The face is commonly involved and is dry and scaly. Xerosis is prominent. Lichenification may be present. A brown macular ring around the neck may occur in adults and adolescents. Amyloid deposition has been demonstrated on ultrastructural evaluation.

Atopic dermatitis in older adults (older-age atopic dermatitis) is a more recently defined subgroup. Skin manifestations are similar to those seen in adolescents and young adults; however, localized lichenified eczema in the elbow and knee folds is rare in older-age atopic dermatitis. Unaffected folds of the elbows and knees are more common, and lichenified eczema surrounding the folds is common, particularly around the antecubital fossae.

Learn more about the presentation of atopic dermatitis.


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