Atopic Dermatitis — Suspected — Clinical Pathway: All Settings

Atopic Dermatitis Clinical Pathway — All Settings

Child with Suspected Atopic Dermatitis (AD)

This pathway is meant to guide the diagnosis and management of patients with atopic dermatitis (AD). AD, also known as eczema, is a common skin disease occurring in 10-20% of all children.

  • AD is long-lasting and waxes and wanes.
  • Patients and caregivers to learn about:
    • Daily general skin care
      • Including use of emollients at least twice daily
    • Recognizing acute flares
    • Acute flare treatment
    • Maintenance treatment
    • Recognizing signs of infection
  • Sleep disturbance is common in children with AD and can impair quality of life.

AD and Age

Infants
  • Begins as early as 2-3 months causing skin to be dry, scaly, itchy
  • Often on scalp, face (chin, cheeks) and more widespread
  • Tendency to weep, especially cheeks
  • Rarely in diaper area
  • Infants rub against clothing, bedding, other objects to scratch
  • Disturbed sleep
  • Note:
  • Patient < 2 months
  • Consider referral to allergy/dermatology if severe AD, FTT, or multiple infections are suspected
  • This may signify underlying:
    • Immunodeficiency
    • Metabolic disorders
    • Nutritional deficiencies
Toddlers and Children
  • Rash begins in creases of the elbows, knees and other folds such as neck, ankles, wrists, crease between legs and buttocks
  • Have bumpy skin known as follicular accentuation
  • Skin may darken or lighten in the footprint of the dermatitis
  • May develop thickening of the skin known as lichenification due to repeated scratching
  • Impaired skin barrier leads to superinfection
  • Molluscum contagiosum and warts are also more common for this reason

Exclusions

  • Known immunodeficiency
  • Oncology patients