Atopic dermatitis (¾ÆÅäÇÇÇǺο°)

The Root of Ambulatory Care
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KEYWORDS:
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Diagnostic Features of Atopic Dermatitis
Major features : 3°³ ÀÌ»ó
Pruritus
Chronic or relapsing dermatitis
Personal or family history of atopic disease : Asthma (30%), allergic rhinitis (2%),
atopic dermatitis (42%)
Typical distribution and morphology of atopic dermatitis rash :
Facial and extensor surfaces in infants and young children
Flexure lichenification in older children and adults
Minor features : 3°³ ÀÌ»ó
Cataracts (anterior subcapsular)
Keratoconus
Infraorbital folds affected : (Dennie-Morgan line)
Facial pallor
Palmar hyperlinearity
Xerosis
Pityriasis alba
White dermatographism
Ichthyosis
Keratosis pilaris
Nonspecific dermatitis of the hands and feet
Atopic
dermatitis
407
The Root of ambulatory care
Nipple eczema
Positive type I hypersensitivity skin tests
Propensity for cutaneous infections
Elevated serum IgE level
Food intolerance
Impaired cell-mediated immunity
Erythroderma
Early age of onset
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¢º Infantile atopic dermatitis
¢º Childhood type atopic dermatitis
Key tests
Atopic
dermatitis
1. No specific laboratory test to confirm diagnosis
Elevated total IgE ¡æ ÀÓ»óÁõ»ó°ú ºñ·Ê
Elevated specific IgE ¡æ Áý¸ÕÁö Áøµå±â, ¿ìÀ¯, °è¶õ ÈòÀÚ, Äá, ¹Ð°¡·ç µî Eosinophilia
Disease Distinguising features
Seborrheic dermatitis Greasy, scaly lesions, absence of family history
Psoriasis Localized patches on extensor surfaces, scalp,
buttocks; pitted nails
Neurodermatitis Usually, a single patch in an area accessible to
itching; absence of family history
Contact dermatitis Positive exposure history, rash in area of
exposure, absence of family history
Scabies Papules, finger web involvement,
positive skin scraping
Systemic Findings on complete history and physical
examination vary by disease
Dermatitis herpetiformis Vesicles over extensor areas associated
enteropathy
Dermatophyte infection Serpiginous plagues with central clearing,
positive potassium hydroxide preparation
Immunodeficiency History of recurrent infection
disorder
¢º Childhood type atopic dermatitis ¢º Adolecsent type atopic dermatitis
409
The Root of ambulatory care
..Atopic dermatitis ȯÀÚ¿¡¼´Â ÀÛÀº ±â°èÀû Àڱؿ¡µµ contact dermatitis°°Àº ¹Î
°¨ÇÑ ¹ÝÀÀÀ» º¸¿© ¿©·¯ º´º¯ÀÌ È¥ÀçÇÒ ¼ö ÀÖ´Ù.
..Consider immunodeficiency and metabolic disorder if dermatitis appears
before 2 months of age.
- General consideration
1. Clip nails to decrease abrasion of skin
2. Shower in warm water once daily for 5~10minutes
3. If possible, limit application of soap to genitalia, axillae, hands and feet
4. Use recommended mild soaps only (e.g., Dove etc)
5. Pat dry : before skin is completely dry, apply lubricant to seal in moisture
6. Avoid contact of allergens or irritants with skin
- pharmacologic
1. Topical Steroid
¢º Group ¥´to¥¶ for infants, face, skin folds
..Dermatop.. cream, oint, sol bid
..Bosong.. cream bid
..Tricot.. 0.1% cream bid
¢º Group ¥°to ¥³ for lichenified areas, adult.
..Erocin.. cream bid
2. Anti-histamines
..Ucerax.. 10mg 2-5mg/kg/day qd
..Clarityne.. 10mg 1/2T-1T qd (30kgÀÌÇÏ 1/2T qd)
3. Antibiotics if necessary
..Bactroban.. bid
..Duricef.. 500mg 1-2C bid
¼Ò¾Æ 15mg/kg/day bid
If severe cases, Oral prednisone 20mg bid for 1~2weeks
Key treatments
Key treatments
Atopic
dermatitis
..Dermatop..-Prednicarbate0.25% (group¥´)
..Tricot..- Triamcinolone acetonide 0.1% (group¥´)
..Bosong..- Prednisolone valerate0.3% cream (group¥¶)
..Erocin..- Mometasone furoate 0.1% (group¥³)
..Ucerax..- Hydroxyzine HCL 1st
..Clarityne..- Loratadine 2nd
..Duricef..-Cefadroximonohydrate: 1st generation
..Bactroban..-Mupirocin
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..Topical agentÀÇ »ç¿ëÀº ÇǺΰ¡ ºÎµå·´°Ô ´À²¸Áú ¶§ ÁßÁöÇϸç, pigmentary
changes¿Í´Â ¹«°üÇÏ´Ù.
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Âü°í ¹®Çå
Mitchell f. Finnie : Atopic Dermatitis,in Saunders Manual of Medical Practice, 2nd ed, Robert E.
Rakel(ed). Philadelphia, Saunders, 2000, P 1199-1201
À̼±¿µ : ¾ÆÅäÇǼº ÇǺο°, in °¡Á¤ÀÇÇÐ ÀÓ»óÆí. ¼¿ï, °èÃø¹®È»ç, 2002, P 1071-1075
Anthony J. Mancini, M.D. : Atopic dermatitis, in Conn's Current Therapy 2004, Robert E. Rakel(ed),
Edward T. Bope(ed_). Philadelphia, Saunders, 2004, P 891-893
¿Àâ¼®(ed) : ¾ÆÅäÇÇ ÇǺο°, in Complete Guide To Practical Based Prescription Medicine. ¼¿ï, Çѿ츮,
2005, P 241-244
°¿øÇü : ¾ÆÅäÇÇ ÇǺο°, in Atlas of Skin disease. ¼¿ï, ÇѹÌÀÇÇÐ, 2002, P 71-88
Christine E. Correale, M.D., Collen Walker, D.O., Lydia Murphy, R.N., B.S.N., Timothy J. Craig, D.O.
: Atopic dermatitis : A review of Diagnosis and Treatment. A journal of the American Family Physicains
1999 ; 60(4) : 1191-1210
ÀÌÇý¿µ ¿Ü : ÇǺΰúÇÐ. ¼¿ï, ±ºÀÚÃâÆÇ»ç, 2003, P 152-153
¾È¼º±¸ ¿Ü (¿ª) : ¼Ò¾ÆÇǺÎÁúȯ. ¼¿ï, ±ºÀÚÃâÆÇ»ç, 2005, P 52