Past Paper: Evaluation and Management of Atopic Dermatitis (Eczema) 2025 PDF

Evaluation and Management of Atopic Dermatitis (Eczema), or Are you itchy yet? Aimee Smidt, MD Chair, Dept of Dermatology Professor of Dermatology and Pediatrics University of New Mexico School of Medicine  Outline/Disclosures Acute e...

Evaluation and Management of Atopic Dermatitis (Eczema), or Are you itchy yet? Aimee Smidt, MD Chair, Dept of Dermatology Professor of Dermatology and Pediatrics University of New Mexico School of Medicine  Outline/Disclosures Acute eczematous inflammation Subacute eczematous inflammation Chronic eczematous inflammation Atopic dermatitis Keratosis pilaris Pityriasis alba Nummular eczema Pompholyx (dyshidrotic eczema) Irritant contact dermatitis Allergic contact dermatitis Rhus dermatitis Lichen simplex chronicus Disparities in images https://hsc.unm.edu/medicine/departments/dermatology/inclusive-dermatology/ Other Resources: AAD Medical Student Curriculum https://www.aad.org/member/education/residents/bdc Society for Pediatric Dermatology handouts https://pedsderm.net/for-patients-families/patient-handouts/ “Acute Eczematous Inflammation” Erythema, edema, vesiculation, erosion, wet/”weeping” Pruritus +/- history trigger Varying etiologies – Atopic flare – Allergic or irritant contact R/O scabies, fungal Treatment: – Avoid trigger – Gentle skin care – Topical steroid – Antihistamine – Rarely, oral prednisone or cyclosporine  “Subacute and chronic eczematous inflammation” Erythema, edema, papules/plaques, dry scale, hyperpigmentation, lichenification Pruritus Varying etiologies – Atopic/atopic-psoriasiform – Allergic or irritant contact – Lichen simplex chronicus R/O scabies, fungal Treatment: – Avoid trigger(s) – Gentle skin care – Topical steroid or other anti-inflammatory – Oral antihistamine – Phototherapy (NBUVB) – Dupilumab (Dupixent) – Methotrexate, cyclosporine etc – JAK1 inhibitors Q: Atopic dermatitis affects what percentage of the US pediatric population? A) Up to 5% B) Up to 8% C) Up to 20% D) Up to 75% E) 100% AD: Prevalence & Epidemiology Range 1-20%; highest industrialized countries Almost 20% US population Increase over last 40 years, similar to asthma Onset: – 45% 0-6 mo – 60% 0-12 mo – >85% 0-5 yrs If onset < 2 yrs: – 20% persistent – 50% asthma Severity AD (+food allergy) increases risk of asthma, AR If +fam hx, early AD, food allergy → almost all will have asthma (“atopic march”)  AD: Differential Diagnosis Psoriasis Contact dermatitis Lichen planus Pityriasis lichenoides Lichen simplex chronicus Seborrheic dermatitis Id reaction Dermatitis herpetiformis Scabies Immunodeficiency Primary ichythyosis And probably more… AD Associations: Ichthyosis Vulgaris Genetic skin disorder Predisposition to dryness Hyperlinearity Plate-like scaling Underrecognized  AD Associations: Keratosis Pilaris (KP) Benign skin “type” Associated w atopy, dry skin, ichthyosis Treatments: No need for referral! Reassurance, education Gentle cleansing (no scrubs/loofah!) Laser if erythema but cosmetic Keratolytics: – Salicylic acid (eg Cerave SA, Eucerin Plus) – Urea (eg Carmol, Excipial) – Lactic acid (eg AmLactin, LacHydrin)  AD: Associations Asthma/RAD Allergic rhinitis Dry skin, ichthyosis Food allergies – Estimate 33% of young kids with moderate to severe AD NOT usually Cause & Effect! Q: Food allergies affect what percentage of the US pediatric population? A) Up to 5% B) Up to 8% C) Up to 20% D) Up to 75% E) 100%  AD & Food Allergy In general population, 12-30% people report food allergy – 6-8% in children