COMEDK 2007 MCQ Answer 49

• 10% of kids in industrialized nations - incidence rapidly increasing
• Onset almost always in infancy, and 60-70% will continue to have some manifestations throughout life
• A large % will develop other atopic diseases and many have family history of atopy

• Severe pruritis, interferes with sleep. Dbn varies with age
  
• 3 mo: scalp, face, extensor surfaces, i.e. where they can rub (diaper spared)
  
• 2 yrs: flexural involvement, neck, antecubital and popliteal fossa, periorbital area, and hands/feet - leading to more chronic lichenification
  
• Adults: similar, including hands, nipple, periorbital
• Associated features include dry skin
  
• ichthyosis vulgaris - auto-dom
  
• abn keratinazation
  
• keratosis pilaris - rough follicular pustules on posterolateral aspects of arms, thighs
  
• pityriasis alba - poorly circumscribed hypopigmented macules
  
• Dennie-Morgan fold - in eyelid, from rubbing
  
• Increased risk for Staph aureus, viral, and fungal infections (impaired cell-med immunity)

• Uncertain, likely to be polygenic
• Linked mutations involve genes that regulate the immune response
• A TH2 dominated disease with increased amounts of IL4, 5, 10 in the skin and blood. Accopanied by increased amounts of IgE and eosinophilia.

1. Moisturize the skin
2. Control itching -antihistamines
3. Decrease inflammation -topical glucocorticoids

Pts w/ severe disease require systemic immunosuppression