NCC Pediatrics Continuity Clinic Curriculum: Atopic Dermatitis ...

Atopic Dermatitis Cases
Case 1:
Colton is a 15 month old male infant who presents for a routine well visit. He is the only child of
well-educated parents who live in the suburbs. His height and weight have been stable at the 50 th
percentile. He was breastfed for the first year of his life and continues to breastfeed at night. He
was introduced to solid foods at 6 months of age and has fully transitioned to table foods. His
mother boasts that he has “never had a runny nose in his life” and that she uses hand sanitizer
“all the time, of course”. Her only concern is for a red, dry, itchy rash that keeps recurring on his
cheeks, arms, and legs. She has not noticed any triggers.
Based on history, what are protective and predisposing factors for Colton developing AD
• Protective: exclusive breastfeeding for at least the first 4
months of life; introduction of solid foods after 4 months of life.
• Predisposing: limited exposure to pathogens and dirt (first born,
no illnesses, over-cleanliness) which could lead to up-regulation of
the Th2 immune response (Hygiene Hypothesis—see diagram);
frequent use of hand sanitizer which can be drying and contain
fragrances/additives that further irritate the skin.
On exam, Colton’s rash appears consistent with a mild-to-moderate eczema flare, with large dry
erythematous plaques covering his cheeks and chin. His arms and legs have multiple papules
and vesicles in the flexural surfaces with scratch marks.
What treatment would you recommend
Discuss with mother that treatment of eczema is a four-prong approach:
1. Moisturization: “Soak and seal”. Bathe 1-2 times a day for 10-15min during flares, using
gentle cleanser without scrubbing, and pat dry. Cover with moisturizer/emollient within 3
min of bath to lock in water. Type of moisturizer is patient/parent preference but should be
hypoallergenic with limited fragrances/additives to prevent further skin irritation. (Refer to
the National Eczema Association Seal of Acceptance).
2. Inflammation Reduction- Topical steroids are the first-line and only treatment approved for
children