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Atopic dermatitis - External and Internal Eye
See also in: Overview,Cellulitis DDx
Other Resources UpToDate PubMed

Atopic dermatitis - External and Internal Eye

See also in: Overview,Cellulitis DDx
Contributors: Azeen Sadeghian MD, Whitney A. High MD, JD, MEng, Harvey A. Brown MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Atopic dermatitis (eczema) is a chronic, relapsing, pruritic condition that is often associated with allergic rhinitis and/or asthma. Infants and children are most often affected, with 85% of cases appearing in the first year of life, and 95% of cases appearing by 5 years. Uncommonly, the condition may persist into, or even arise in, adulthood. Less than 1% of adults are affected by atopic dermatitis.

In infants, the disease involves primarily the face, scalp, and torso. In children and adults, the disease usually involves chiefly the flexural aspects of extremities, but it may be more generalized.

Atopic dermatitis may be categorized as follows:
  • Acute – erythema, vesicles, bullae, weeping, crusting
  • Subacute – scaly plaques, papules, round erosions, crusts
  • Chronic eczema – lichenification, scaling, hyper- and hypopigmentation
Follicular eczema is a subtype of eczema based on morphology.

The cause of atopic dermatitis is unknown. Genetic and environmental predisposing factors exist. Multiple loci have been associated with atopic dermatitis. A family history of atopic dermatitis is common. Patients with atopic dermatitis have difficulties in retaining skin moisture and suffer from xerosis (dry skin). Environmental triggers, such as heat, humidity, detergents / soaps, abrasive clothing, chemicals, smoke, and even stress, tend to aggravate the condition. Latex allergy and nickel allergy occur more often in persons with atopic dermatitis. Additionally, patients with atopic dermatitis have been found to be more likely to have positive patch test results to products commonly found in topical treatments, including cocamidopropyl betaine, wool alcohol / lanolin, and tixocortol pivalate. Allergy to eggs, cow's milk, or peanuts is common. There may be a relationship between atopic dermatitis and the development of aspirin-related respiratory disease.

Intense pruritus (itching) is a hallmark of atopic dermatitis. Scratching leads to lichenification (skin thickening). Eyelid skin may be involved with scaly or lichenified plaques. Impaired barrier function leads to increased transepidermal water loss and the risk of bacterial and viral cutaneous infections. Patients with atopic dermatitis are prone to impetiginization with Staphylococcus aureus. Secondary infections with herpes simplex virus (eczema herpeticum), molluscum contagiosum, Coxsackie virus, or vaccinia virus (eczema vaccinatum) can occur.

Atopic keratoconjunctivitis is characterized by ocular pruritus, burning, and tearing. It is usually associated with concomitant dermatitis and asthma and affects 20%-40% of those with dermatitis, being seen somewhat more often in males.

Posterior subcapsular cataracts are typically asymptomatic and can be seen in adult patients with severe atopy. They rarely occur in children. Factors driving the development of cataracts in atopic dermatitis may be the disease itself or corticosteroid therapy. Keratoconus is reported in about 1% of patients with atopic dermatitis and appears to develop independently of cataract formation.

Codes

ICD10CM:
L20.9 – Atopic dermatitis, unspecified

SNOMEDCT:
24079001 – Atopic dermatitis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

When keratoconjunctivitis is present, it must be differentiated from the following:

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:03/31/2017
Last Updated:02/17/2020
Copyright © 2021 VisualDx®. All rights reserved.
Atopic dermatitis - External and Internal Eye
See also in: Overview,Cellulitis DDx
Atopic dermatitis : Bilateral distribution, Dry skin, Erythema, Excoriated skin lesion, Flexural distribution, Lichenified plaque, Thickened skin, Ocular pruritus, Pruritus
Clinical image of Atopic dermatitis
A close-up of follicular papules with scale.
Copyright © 2021 VisualDx®. All rights reserved.