Traducido al: Español Mostrar imagen original Opciones ▼

Dermatitis

Dermatitis atópica
Creado en 2008.

Objetivos de aprendizaje
Identificar y manejar la dermatitis atópica

Características clínicas
La dermatitis atópica afecta hasta al 20% de la población infantil y causa una angustia y una salud considerables. Su prevalencia es
mayor en la infancia, comenzando generalmente en los primeros meses de vida, volviéndose más severa en la infancia y mejorando
a menudo en los años escolares.

El diagnóstico depende de los hallazgos clínicos, que varían con la edad y el estadio de la enfermedad. Las características principales
son:

Prurito marcado , que con frecuencia resulta en liquenificación.

Exacerbaciones intermitentes ( brotes agudos )
Asociación con antecedentes personales o familiares de dermatitis atópica, rinitis alérgica y/o asma
Piel seca

Un índice de puntuación ( SCORAD ) que combina la extensión, la gravedad y los síntomas subjetivos, se utiliza a menudo en los
ensayos clínicos que evalúan la eficacia de los tratamientos.

Los sitios afectados varían con la edad. El eccema infantil comúnmente afecta la cara, sin afectar alrededor de la boca y luego las
manos, los pies y otros lugares.

Dermatitis atópica infantil

Dermatitis atópica Dermatitis atópica Dermatitis atópica

En niños mayores, el eczema tiende a afectar las flexuras , particularmente las fosas antecubital y poplítea .

Dermatitis atópica infantil

https://dermnetnz.org/cme/dermatitis/atopic-dermatitis# 1/5
 Dermatitis atópica Dermatitis atópica Dermatitis atópica Dermatitis atópica

Dermatitis atópica Dermatitis atópica

La dermatitis flexural a menudo persiste en la vida adulta. De vez en cuando, se observa un 'cuello sucio' en los adolescentes. El
eccema de manos irritante puede ser un problema para quienes realizan trabajos húmedos. El eccema bilateral del pezón no es
infrecuente.

Dermatitis atópica del adulto

Dermatitis atópica Dermatitis atópica Dermatitis atópica Dermatitis atópica

Dermatitis atópica Dermatitis atópica

El eczema eritrodérmico se refiere a la afectación de todo el cuerpo a cualquier edad.

Los brotes pueden ser precipitados por:

Exotoxinas de Staphylococcus aureus , que actúan como superantígenos

Irritantes , especialmente deshidratación de la piel por exceso de lavado, ropa de lana
Inhalant allergens especially house dust mite (which may also be a contact allergen)
Ingested allergens in some infants (eggs, milk, soybeans, peanuts and wheat account for most of these)
Emotional stress

Atopic eczema may be complicated by microbial colonisation or infection:

Staphylococcus aureus (impetiginised eczema)

Streptococcus pyogenes
Herpes simplex (eczema herpeticum)
Warts
Molluscum contagiosum
Malassezia spp.

https://dermnetnz.org/cme/dermatitis/atopic-dermatitis# 2/5
 Complications of atopic dermatitis

Impetiginised eczema Molluscum contagiosum Eczema herpeticum

The pathogenesis appears involve release of vasoactive substances from mast cells and basophils as an IgE-mediated
hypersensitivity reaction. There is a TH2 pattern of cytokine release from T helper lymphocytes in the epidermis and dermis with low
levels of TH1 lymphocytes and gamma interferon. There is also a non-allergic or intrinsic type of atopic dermatitis. These patients
have no associated respiratory diseases, show normal total serum IgE levels, no specific IgE, and have negative skin-prick tests to
aeroallergens or foods.

It is not known why the incidence of atopic dermatitis appears to be increasing; theories include increased hygiene and decreased
exposure to micro-organisms and greater exposure to house dust mite.

A proportion of patients have been found to be deficient in fillagrin, resulting in abnormal barrier function of the stratum corneum
and increased susceptibility to the effect of contact irritants. These individuals have dry skin (ichthyosis vulgaris).

Investigations
In most cases, no specific investigations are required. However, on occasion the following may be useful:

Skin swabs for bacteriology: to identify methicillin resistant strains of Staphylococcus

Viral culture: to confirm eczema herpeticum
Iron studies: severe eczema can result in iron deficiency; iron deficiency aggravates pruritus
Total IgE: elevated IgE confirms atopy but normal levels may occur in non-allergic patients
RAST tests (specific IgE): negative tests have a high predictive value, positive test results are not so useful
Prick tests: positive test results may simply confirm an atopic diathesis
Patch tests: to rule out specific contact allergy for example to an applied medicament

Management
The best way to manage atopic dermatitis is unknown. At present, management of atopic eczema in patients of all ages involves:

Avoidance of aggravating factors: use soap substitutes; don't wear woollen garments or perfumed cosmetics; ensure adequate
rest; reduce stress
Fans and wet dressings to cool hot and inflamed skin
Emollients applied as often as is required to keep the skin hydrated and comfortable
Topical immunomodulators, also known as calcineurin inhibitors (pimecrolimus cream)
Topical corticosteroid creams and/or ointments for flare-ups
Oral antibiotics, usually flucloxacillin or dicloxacillin, for bacterial infection
Non-sedating antihistamines for patients with an element of urticaria.
Sedative antihistamines at night to allow adequate rest.
In severe cases, refer for phototherapy, azathioprine, methotrexate or ciclosporin

Eczema treatment

https://dermnetnz.org/cme/dermatitis/atopic-dermatitis# 3/5
 Phototherapy Applying cream Tube gauze wet dressings Shoulder detail

Potent topical steroids should be used with caution in infants because of their greater proportional absorption due to higher surface
area to body weight ratio. Blistered or weeping eczema is brought under control most rapidly using wet dressings.

Oral corticosteroids are used for crisis intervention but may be followed by a severe rebound flare at discontinuation. It is important
to taper the dose and begin intensified skin care with topical steroids and bathing followed by application of emollients.

Facial eczema

Use light emollients in adolescents and adults to avoid provoking acne or perioral dermatitis. It is safe to use 0.5-2% hydrocortisone
cream on active eczema indefinitely, although in time it is likely to lose its efficacy. Pimecrolimus cream can also be used as
maintenance treatment. Severe eczema may require moderate potency topical steroids for a course of 5 to 10 days or as pulse
therapy. A trial of antifungal agents may be warranted in adults with prominent facial eczema.

Facial atopic dermatitis

Atopic dermatitis Atopic dermatitis Atopic dermatitis

Trunk and limbs

These sites may require thicker emollients (sorbolene cream, white soft paraffin, emulsifying ointment, fatty cream) and moderate
potency topical steroid fatty cream or ointment, with potent topical steroids for flare-ups. It is often useful to apply the potent
preparation prophylactically on two consecutive days each week (pulse therapy). Ultrapotent products may be required for severe
lichenification.

Atopic dermatitis on trunk and limbs

Atopic dermatitis Atopic dermatitis Atopic dermatitis

Hands and feet

https://dermnetnz.org/cme/dermatitis/atopic-dermatitis# 4/5
 Hands and feet

The very thick stratum corneum of palmoplantar sites necessitates the use of ultrapotent topical steroids such as clobetasol
propionate, generally in an ointment base, for two to four weeks. Advise frequent use of emollient barrier creams that contain
dimethicone and/or petrolatum, and careful protection against irritants.

Atopic dermatitis on hands

Atopic dermatitis Atopic dermatitis Atopic dermatitis

Axillae and groins

Flexures do not generally require emollients. Potent topical steroids are rarely required, and should only be used for a few days.
Hydrocortisone cream or pimecrolimus cream is generally adequate.

Allergens
Dermatologists rarely recommend dietary manipulation for atopic dermatitis because it is troublesome, expensive and not often
helpful. However, about 30% of children with eczema also have food allergies causing urticaria and anaphylactic responses. In some
of these, certain foods may consistently aggravate their eczema. The most well established food allergies associated with eczema are
to egg, milk, peanut, wheat, and soy.

If there is a strong suspicion of food allergy, a specific RAST test reaction or positive prick test may be supportive but should be
confirmed with controlled food challenges and a limited elimination diet that results in consistent clinical improvement. Extensive
elimination diets can be nutritionally deficient and are useless. Most affected children outgrow their food hypersensitivity.

Extended avoidance of house dust mites in sensitised patients with atopic dermatitis is reported to be helpful but is difficult to
achieve. Avoidance measures include use of house dust mite-proof encasings on pillows, mattresses, and duvets; washing bedding in
hot water weekly; removal of bedroom carpets; and decreasing indoor humidity levels.

Immunotherapy has not been found to be useful.

Activity
Describa la evidencia a favor y en contra del valor de (a) la lactancia materna y (b) los probióticos en la prevención de la dermatitis
atópica en los bebés.

© 2023 DermNet Nueva Zelanda Trust.

DermNet does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice.

https://dermnetnz.org/cme/dermatitis/atopic-dermatitis# 5/5