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Mastering Atopic Dermatitis Treatment in Primary Care
Key Points on Atopic Dermatitis (AD)
- Clinical Presentation:
- Red, scaly, itchy, dry, inflamed skin
- Often involves face, trunk, extremities, and especially flexural areas
- Common in childhood but can occur at any age
- Chronic condition with repeated flares
- Associated findings: Dennie-Morgan lines, keratosis pilaris, hyperlinear palms
- Patient Demographics:
- Presentation varies by ethnicity:
- African American patients: More fibrotic/papular lesions
- Asian patients: May have psoriasis-like scaling
- Comorbidities:
- Asthma, allergies, allergic rhinitis
- Often has familial occurrence
- Differential Diagnosis:
- Psoriasis: More silvery scale
- Seborrheic dermatitis: Greasy yellow scale (brows, nasolabial folds, scalp)
- Scabies: Papules in web spaces, umbilicus, axilla, breasts, genitals
- Pityriasis rosea: “Christmas tree” pattern
- Tinea corporis: Salmon-colored with annular/ring-like scaling
- Contact dermatitis: Often concurrent with AD due to home remedies
- Mycosis fungoides/cutaneous T-cell lymphoma: Important consideration in adults with “bathing suit distribution” rash unresponsive to AD treatments
Clinical Pearls
- Primary care providers are on the front lines of diagnosing AD
- Patient/family history and distribution pattern are key diagnostic factors
- Patients often have multiple concurrent conditions
- Consider mycosis fungoides in adults with treatment-resistant presentations