Atopic Dermatitis

Atopic dermatitis is a pruritic disease of unknown origin. It is is an inflammatory, relapsing, non-contagious and pruritic skin disorder.

The disorder is characterized by eczematous lesions, dry skin, and thickening of the skin.


Atopic dermatitis may be associated with other atopic diseases such as asthma, allergic rhinitis, urticaria, acute allergic reactions to foods.

The skin affected by atopic dermatitis reacts abnormally to irritants, food, and the environment. The skin becomes red, flaky and itchy.

It is a familial and chronic disease and the symptoms can increase or disappear with time.

Causes:

Genetics - A family history of atopic dermatitis is often common.

Infection - The skin atopic dermatitis is colonized by S aureus. This can cause a flare of atopic dermatitis.

Hygiene - Hygiene may be a cause for atopic dermatitis.

Climate - Atopic dermatitis flares occur in different climates. Heat and cold are poorly tolerated.

Differential Diagnosis:

Contact Dermatitis - A localized rash or irritation of the skin caused by contact with a foreign substance

Lichen Simplex Chronicus- A skin disorder that leads to chronic
itching and scratching


Nummular Dermatitis - A form of eczema that is characterized by round-to-oval erythematous plaques

Psoriasis - A common skin condition that causes skin redness and
irritation

Seborrheic Dermatitis - An inflammatory skin disorder that causes scaly, flaky, itchy, red skin

Tinea Pedis - A dermatophyte infection of the soles of the feet and the interdigital spaces


Lab Studies:

Skin scraping for pathological exam may be helpful to exclude tinea pedis.

Biopsy may be helpful to show an acute, subacute, or chronic dermatitis.


Medications/Treatments:

Anti-inflammatory agents provide relief of inflammation of eczematous lesions.

Topical steroids are the mainstay of treatment

Mild topical corticosteroid - Hydrocortisone ointment 1%

Medium strength topical corticosteroid - Betamethasone valerate

Immune Modulators are medicated creams that are used for the treatment of atopic dermatitis.

Tacrolimus


Pimecrolimus 1%


Moisturizing -
Patients usually benefit from lukewarm soaks followed by the application of a moisturizer.

Other treatments -

Both hydroxyzine and diphenhydramine provide relief from itching. Antibiotics are used for the treatment with infection caused by S aureus.

Tailor's Bunion

Tailor's bunion is as an acquired lesion that causes chronic pain and swelling over the outer aspect of the distal foot. It is also known as a bunionette and is characterized by a painful prominence on the outer aspect of the foot in the area of the fifth metatarsal head.

These types of lesions were often seen on tailors with a cross-legged sitting posture. The posture resulted in pressure being placed on the lateral side of the foot.

Causes

Extrinsic causes - Commonly chronic

• Tailors' posture
• Footwear

Intrinsic causes

Structural Abnormalities

• Lateral bowing of the metatarsal shaft
• Enlargement of the metatarsal head
• Congenital splayfoot

Presentation

• Symptoms - Painful keratoses on the outer, bottom, or top aspect of the metatarsal head.

Imaging Studies

• Weight-bearing x rays of both feet
• Vascular studies are important with patients who have questionable circulation

Treatment

Conservative

• Padding
• Shoe modification
• Orthotic devices
• Anti-inflammatory medications
• Corticosteroid injections

Surgical Treatment

• Can be treated with simple removal of osseous bump when there is no evidence of anglular deformity
• With an angular deformity or a deviation in the bone is present an osteotomy (cut in the bone) is made and held together with a screw. The level of bone cut varies with the level of the deformity.

Possible Complications

• Malunion- Incomplete union or union in a faulty position
• Nonunion- A nonunion occurs when a broken bone does not heal
• Nerve Injury
• Joint pain and stiffness
• Symptomatic hardware
• Infection
• Recurrence