HJ's (ignore)

Eczema (atopic dermatitis)

History (HPI)	Physical Exam
Pruritus ⭐ hallmark	Dry/xerotic skin
Red, dry, itchy rash	Erythematous, scaly patches/plaques
Often chronic/relapsing	Excoriations from scratching
Flares with soaps, fragrances, heat/sweating, dry weather	Chronic disease → lichenification
Ask about new products/exposures	Infants: face/scalp + extensor surfaces
Ask about asthma/allergic rhinitis (atopic triad)	Older children: flexural surfaces—antecubital & popliteal fossae
Ask about sleep disturbance from itching	Look for infection: crusting, drainage, pustules, warmth

Skin warm and dry with erythematous, xerotic, scaly patches involving bilateral antecubital fossae with mild excoriations. No drainage, crusting, warmth, or other evidence of secondary infection.

First-line = moisturizers + topical corticosteroids for flares.

• Daily skin care: Thick, fragrance-free emollient (petrolatum/cream) at least 2×/day, especially immediately after a short lukewarm bath.

• Itching: Moisturization is key; a sedating antihistamine may sometimes be used short-term at night if itching significantly disrupts sleep, but antihistamines do not treat the eczema itself.

• _{Secondary bacterial infection: Treat only if signs such as honey-colored crusting, pustules, drainage, or spreading erythema are present.}

how do you tx atopic dermitis ?

(general daily tx)

• Mild flare / face or folds: Low-potency steroid such as hydrocortisone 1–2.5%.

• Moderate body flare: May use a medium-potency topical steroid (e.g., triamcinolone 0.1%) for a short course;

  • avoid higher potency on face/groin/folds unless specifically directed.

• Persistent/recurrent disease: Topical calcineurin inhibitor (tacrolimus/pimecrolimus) can be steroid-sparing, especially for sensitive areas.

how to atopic dermitis

mild

moderate

persistant

	Irritant contact dermatitis	Allergic contact dermatitis
Mechanism	Direct skin damage	Type IV hypersensitivity ⭐
Requires prior exposure?	No	Yes — sensitization required
Symptoms	Burning > itching	Itching > burning
Appearance	Red, dry, cracked skin	Pruritic erythema, papules/vesicles
Distribution	Where irritant touched	Contact area; may spread beyond
Examples	Soap, saliva, frequent handwashing, diaper area	Poison ivy, nickel, fragrances

REMOVE TRIGGERS

irritant vs allergic

contact dermatitis

Seborrheic dermatitis

(cradle cap)

Cradle cap, greasy yellow scales

Ketoconazole shampoo/cream, Mineral oil, Hydrocortisone

how to tx seborrheic dermatitis

Pityriasis rosea

Oval, salmon-colored patches/plaques with fine collarette scaling distributed along skin cleavage lines of the trunk.

Pityriasis rosea

Herald patch first ⭐ — single, oval, salmon/pink, scaly plaque, usually on trunk

 followed by Christmas-tree rash

assocaited with HHV6/7

Self-limited → reassurance; antihistamines/topical steroids for itching

Duration

Usually resolves in 6–8 weeks

tx for Pityriasis rosea