engleski

Atopic dermatitis - resemblance with other common face skin changes

Atopic dermatitis on the face is chronic pruritic, clinically variable skin disease associated with atopy. Clinical features vary greatly with age of the patient. In young patients, the changes are quite acute with erythema, blisters, and crusts, whereas later on more chronic changes, including lichenification, are predominating. A single constant symptom seems to be pruritus, resulting in patients rubbing and scratching their skin. Patients with atopic dermatitis on the face have very dry skin, which is often made worse by almost any cleansing agent or even just frequent exposure to water. In adult patients, skin changes appear mostly with red patches on eyelids, forehead, perioral region, nape, and neck, often following emotional stress. The skin acquires a gray-yellow color making the patient appear older and sadder. Postinflammatory hyperpigmentation is common, most frequently seen around the eyes, and often associated with increased skin folds. While atopic deramtitis in infancy and childhood is not a diagnostic problem, it can be in older patients. Atopic dermatitis can resemble other common facial skin changes, such as seborrheic dermatitis, contact dermatitis (allergic or irritant), nummular eczema, psoriasis vulgaris, ichthyoses, and cutaneous T-cell lymphoma. Atopic dermatitis can also be complicated with bacterial (Staphylococcus aureus), viral, and fungal (Pityrosporum ovale) infections that can modify a clinical picture. One of the serious problems is the abuse or uncontrolled application of topical steroids. In example, one of our patients, a 55-year-old woman with atopic dermatitis from early infancy, applied topical steroids for 25 years on her face. Lately she has devdeloped heavy contact allergic dermatitis with positive patch test on several allergens.

atopic dermatitis; face; differential diagnosis

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