Atopic dermatitis – a report of severe case at 7-year-old girl – case report
Bolesław Kalicki, Anna Maślany, Małgorzata Placzyńska, Agnieszka Rustecka, Anna Jung
Atopic dermatitis (AD) is a chronic, inflammatory dermatological disease with intermittent course, very dry skin and pruritus. Prevalence rates for atopic dermatitis in children is increasing and range from 1 to about 20%. The previous studies indicates that genetic factors, environmental factors, infectious factors and immunological mechanisms are important in the pathogenesis of atopic dermatitis. Depending of the child’s age we can distinguish three stages of the disease. Typical affected skin areas in infants include the face, chest and extensor surfaces of the extremities whereas in the older children lesions are seen mostly over the flexor surfaces (antecubital and popliteal fossa) around the wrists and ankles. The earliest lesions are in the form of papules with erythema and exudation, but with time it forms crusted plaques and repeated rubbing of the skin makes lichenification. The diagnosis is based on clinical feature. Hanifin and Rajka Diagnostic Criteria listed below are the most commonly used one. These are also the criteria proposed by the American Academy of Dermatology in 2003. The disease is often accompanied by eosinophilia, elevated immunoglobulin E and positive skin prick tests. In the thesis we have presented the most frequent diseases requiring differentiation from AD. Treatment of atopic dermatitis includes systematic skin moisturizing and, in acute phase, the use of anti-inflammatory drugs (glucocorticosteroids and calcineurin inhibitors), antibacterial medications and anti-histaminics. The paper also discusses the severe form of AD proceeding with extreme eosinophilia and hypergammaglobulinaemia E in 7-year-old girl hospitalised in the Department of Paediatrics WIM.