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Atopic dermatitis (¾ÆÅäÇÇÇǺο°)

The Root of Ambulatory Care (¿Ü·¡ Áø·á Áöħ¼­) Àüü ¸ñ·Ï º¸±â
KEYWORDS: ..¾ÆÅäÇǼº ÇǺο°Àº 10%ÀÇ ¾ÆÀ̵鿡°Ô »ý±â¸ç °¡Á··ÂÀÌ ÀÖ°í À¯ÀüÀû, ¸é¿ªÇÐ Àû, ȯ°æÀû ¿äÀÎÀÌ °ü¿©ÇÑ´Ù. ..õ½Ä(34%), ¾Ë·¹¸£±â¼º ºñ¿°(9%)ÀÌ ¾ÆÅäÇǼº ÇǺο°ÀÌ Àִ ȯÀÚ¿¡¼­ ÈçÈ÷ µ¿¹ÝµÈ´Ù. 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 ..À¯¾Æ±â¿¡´Â ¾ó±¼°ú µÎÇÇ¿¡ °ÉÃÄ ³ªÅ¸³ª¸ç ¸ñ°ú ¸öÀ¸·Î ¹øÁø´Ù. 1-2¼¼ÀÇ ¼Ò¾Æ ¿¡¼­´Â º´º¯ÀÌ ÀüÁÖºÎ, ½½¿ÍºÎ, ¸ñºÎÀ§, ¼Õ¸ñ, ¹ß¸ñºÎÀ§·Î ¿Å°Ü°¡¸ç û¼Ò³â±â ÀÌÀü¿¡ 40%¿¡¼­ ÀÚ¿¬ÀûÀ¸·Î Áõ»óÀÌ ÁÁ¾ÆÁø´Ù. ..µå¹°±ä ÇÏÁö¸¸ ÀüüȯÀÚÀÇ 0.1%´Â 30¼¼ ÀÌÈÄ¿¡ À̸£·¯¼­ ÃÖÃÊ·Î ¾ÆÅäÇÇ ÇÇ ºÎ¿°ÀÌ ¹ßº´ÇÒ ¼ö ÀÖ´Ù. ¢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 ..±¹¼Ò ½ºÅ×·ÎÀ̵å Á¦Á¦´Â °­µµ¿¡ µû¶ó 7°³ÀÇ ±×·ìÀ¸·Î ³ª´µ¾îÁø´Ù. ..Topical agentÀÇ »ç¿ëÀº ÇǺΰ¡ ºÎµå·´°Ô ´À²¸Áú ¶§ ÁßÁöÇϸç, pigmentary changes¿Í´Â ¹«°üÇÏ´Ù. ..Anti-histamineÁ¦Á¦´Â Áõ¼¼ ÀÖÀ» ¶§¸¸ »ç¿ëÇÏÁö ¸»°í, itch-scratch cycleÀ» Á¶Àý Çϱâ À§ÇÏ¿© ÃÖ¼Ò 2-3ÁÖ¸¦ Áö¼ÓÀûÀ¸·Î º¹¿ë½ÃŲ´Ù. Sedating effect ¸¦ °¡Áø Á¦ Á¦µéÀÌ º¸´Ù È¿°úÀûÀ̳ª ³·½Ã°£ÀÇ sedationÀÌ ¹®Á¦°¡ µÈ´Ù¸é Àú³á¿¡ ÀÌµé ¾à Á¦¸¦ º¹¿ëÇÑ´Ù. 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