OUTLINE

● Introduction of the disease (atopic dermatitis)

- Creative introduction of the nature of the disease
- Clinical signs and symptoms
- Where/How it may be acquired
- General ways of prevention and treatments
● Case Study presentation: Atopic Dermatitis: A Case Report of a 3-Year-OldFood Allergy
Child Sensitive to Multiple Allergens
- Introductory sentence
- Describe the essential nature of the complaint, including location, intensity and
associated symptoms
- Evolution of the complaint
- Describe relieving and aggravating factors, including responses to other
treatment
- Health history, including family’s
- Result of examination
- Diagnosis
- Treatment (i.e., treatment provided, including nature of the treatment, and the
frequency and duration of care and Resolution of care)

PRESENTATION PROPER
Introduction
Often, it is said that the integumentary system is the first line of defense
against pathogenic substances and organisms, especially
microorganisms—fungi, bacteria, and the likes—which, although tiny, can
completely overhaul the homeostatic equilibrium of the body’s systems.
The skin, its most prominent organ, can additionally be a good indicator
of internal imbalances, such as when it changes color, itches, or alters
texture. Such is the indication of dermatitis—inflammation of the skin that
can have various causes and forms.
Dermatitis primarily affects the skin, which is the body's largest organ and
is lined with stratified squamous epithelium. However, the effects of
dermatitis can extend beyond the epithelial layer and involve other skin
components, such as the underlying connective tissue, blood vessels, and
immune cells.
In dermatitis, the inflammatory response typically starts in the skin's outer
layers (epidermis) and can extend into the deeper layers (dermis). This
can lead to various symptoms, including redness, itching, swelling, and
sometimes the formation of blisters or lesions.
While the primary site of inflammation is the skin, severe or chronic
dermatitis can have systemic effects. For example, persistent itching and
scratching can lead to skin infections, and the chronic inflammation
associated with conditions like atopic dermatitis can affect a person's
overall health and well-being.

Clinical Signs and ● Itching/Pruritus. This is a hallmark symptom of dermatitis. It can

Symptoms range from mild to severe and is often the most bothersome
symptom.
● Redness/Erythema. The affected skin may appear red or flushed.
● Swelling/Edema. Swelling of the skin is common, especially in
contact dermatitis.
● Rash. Dermatitis typically presents as a rash, which can vary in
appearance. It may be dry, scaly, or oozing with fluid (vesicles or
blisters).
● Dryness and Scaling. The skin may become dry, flaky, and scaly.
● Pain or Discomfort. In some cases, dermatitis can be painful or
 uncomfortable, especially if it becomes infected.
● Cracking and Peeling. The skin can crack and peel, leading to
open sores in severe cases.

Pathophysiology 1. Etiology/ Risk Factors

2. Inflammatory reaction in skin
3. Eruption of skin
4. Erythema, vesicles, pruritus will occur
5. Continuous irritation and scratching over the skin
6. Long term irritation
7. Thickening of the skin

Types and Risk 1. Contact Dermatitis. This occurs when the skin comes into
Factors contact with an irritant (irritant contact dermatitis) or an allergen
(allergic contact dermatitis). It triggers an inflammatory response
in the skin, leading to the characteristic symptoms.
● Irritants: Contact with irritants like soaps, detergents,
cleaning products, or chemicals can cause irritant contact
dermatitis.
● Allergens: Allergic contact dermatitis occurs when the skin
reacts to allergenic substances like certain metals (nickel),
cosmetics, or latex.
● Occupation: Jobs that involve frequent contact with
irritants or allergens increase the risk of occupational
contact dermatitis.
2. Atopic Dermatitis/Eczema. Atopic dermatitis is often associated
with a genetic predisposition and an abnormal immune response. It
involves a complex interplay of genetic, environmental, and
immune factors.
● Family History: A family history of atopic dermatitis,
asthma, or allergic rhinitis increases the risk.
● Allergies: Individuals with allergies, especially to certain
foods, pollen, or animal dander, are at a higher risk.
● Environmental Allergens: Exposure to allergens like dust
mites, mold, or pet dander can trigger atopic dermatitis.
● Climate: Dry or cold climates can exacerbate symptoms.
● Stress: Psychological stress can worsen symptoms.
3. Seborrheic Dermatitis. This is linked to an overgrowth of yeast
on the skin's surface and increased sebum production. It
commonly affects areas with a high density of sebaceous glands,
like the scalp and face.
● Age: Infants and adults between the ages of 30 and 60 are
more prone.
● Hormones: Hormonal changes, such as those during
puberty or with certain medical conditions, can trigger
seborrheic dermatitis.
● Oily Skin: Excessive oil production on the skin's surface is
a contributing factor.
● Yeast: The presence of a yeast called Malassezia on the
skin can worsen seborrheic dermatitis.
4. Nummular Dermatitis. The exact cause is unclear, but it's
believed to involve skin dryness, irritation, or an immune reaction.
Also called discoid eczema, it features scattered, circular, often
itchy and sometimes oozing patches.
● Dry Skin: People with naturally dry skin or those living in
dry climates are at a higher risk.
● Cold Weather: Winter weather can exacerbate symptoms.
● Hot Showers: Taking long, hot showers can dry out the
skin and increase the risk.
5. Perioral Dermatitis. Perioral dermatitis is a facial skin condition
that typically affects the area around the mouth, including the lips
and sometimes the eyes or nose. It appears as red, bumpy, or
 pimple-like rashes and can be itchy or uncomfortable. This
condition is often linked to the use of topical steroids, certain
cosmetics, or dental products.
Topical Steroids: Prolonged use of topical steroids on the face is a
risk factor.
● Cosmetics: Use of certain cosmetics or dental products can
contribute.
● Oral Contraceptives: Some cases have been linked to the
use of birth control pills.
6. Diaper Dermatitis Commonly known as diaper rash, it presents
as red, inflamed, and sometimes raised patches on the baby's
buttocks, genitals, or thighs. This condition is typically caused by
prolonged exposure to wet diapers, friction, or contact with urine
and feces.
● Infancy: Infants are at risk due to prolonged exposure to
wet diapers.
● Chafing: Friction and chafing can contribute.
● Irritants: Exposure to urine or feces can cause irritation.

Prevention Identify and Avoid Triggers: For contact dermatitis, identify and
avoid irritants or allergens that cause the reaction. This may
involve changes in personal care products, detergents, or
work-related exposures.
Skin Hydration: Keeping the skin well-moisturized can help
prevent dermatitis, especially in dry climates.
Avoid Scratching: Scratching can worsen dermatitis. Keep nails
short, and consider wearing cotton gloves at night to prevent
scratching during sleep.
Manage Stress: Stress can exacerbate dermatitis. Stress reduction
techniques like meditation or yoga may be helpful.

Treatment Topical Steroids: These are commonly used to reduce

inflammation and itching. They come in various strengths and
should be used under medical guidance.
Emollients: Moisturizers and emollients help keep the skin
hydrated and can reduce dryness and itching.
Antihistamines: These can help relieve itching, especially if it's
interfering with sleep.
Avoiding Triggers: If the dermatitis is triggered by a specific
substance, avoiding that substance is crucial.
Prescription Medications: In severe cases or when infection is
present, oral antibiotics or antifungal medications may be
prescribed.
Phototherapy: In some cases, exposure to controlled ultraviolet
(UV) light can help improve symptoms.
Immunomodulators: These are topical or oral medications that can
modulate the immune response and are used in specific cases.

Atopic dermatitis is called "atopic" because it is one of the conditions

associated with atopy. Atopy is a genetic predisposition to develop
allergic diseases, including asthma, hay fever (allergic rhinitis), and atopic
dermatitis. When someone is "atopic," it means they have a tendency to
develop these allergic conditions.
Dermatitis refers to inflammation of the skin. It is often used
interchangeably with the term "eczema." Dermatitis can have various
causes, including allergies, irritants, infections, or underlying health
conditions. When it comes to atopic dermatitis, it is a specific type of
eczema that is associated with allergies and immune system dysfunction.
Atopic dermatitis primarily affects the skin. It is characterized by red,
 itchy, and inflamed patches of skin. These patches can appear anywhere
on the body but are most commonly found on the face, neck, inner
elbows, and behind the knees. While it primarily affects the skin, the
condition can have broader implications. For example, people with atopic
dermatitis may be more prone to skin infections due to the disruption of
the skin's barrier function.
It's important to note that atopic dermatitis is considered a chronic
condition, and its exact cause is not fully understood. It often occurs in
individuals with a family history of atopic conditions and may be
triggered or exacerbated by allergens, irritants, stress, or other factors.
Managing atopic dermatitis typically involves skincare routines, avoiding
triggers, and sometimes medications to control symptoms and prevent
flare-ups.
People with atopic dermatitis often have immune system dysregulation.
Their immune systems may react abnormally to certain allergens or
irritants, leading to inflammation and skin symptoms. There can be an
imbalance in immune responses, with an overactive inflammatory
response contributing to skin issue. Additionally, People with atopic
dermatitis often have a compromised skin barrier. The skin's outermost
layer, called the stratum corneum, is responsible for keeping moisture in
and irritants out. In atopic dermatitis, this barrier is often impaired,
allowing moisture to escape and irritants to penetrate, leading to dryness
and inflammation. Some individuals with atopic dermatitis have genetic
mutations that affect a protein called filaggrin. Filaggrin plays a crucial
role in maintaining the skin barrier. Mutations in the filaggrin gene can
lead to a weaker skin barrier, making the skin more susceptible to irritants
and allergens. Chronic inflammation in the skin is a hallmark of atopic
dermatitis. The immune system's inflammatory response can lead to
redness, itching, and the characteristic rash associated with the condition.
Recent research suggests that alterations in the skin's microbiome (the
community of microorganisms that naturally inhabit the skin) may also
play a role in atopic dermatitis.
Atopic dermatitis is a complex condition influenced by genetic, immune,
and environmental factors. It primarily affects the skin but can have
broader implications, especially when skin barrier dysfunction allows for
increased susceptibility to infections and allergens. Treatment often
focuses on repairing the skin barrier, managing inflammation, and
addressing triggers to minimize symptoms and flare-ups.

CLINICAL CASE STUDY

Title. Atopic Dermatitis: A Case Report of a 3-year-old Food Allergy Child Sensitive to
Multiple Allergen

Introduction ● A.k.a. atopic eczema

● Flare-ups of eczematous pruritic lesions above dry skin
● Starts as atopic march in early childhood
● 50% develop allergic symptom with/in first year after being born
● 85% experience onset below age of 5 year
● 70% undergo spontaneous remission during around childhood
● For some, this is early indication of asthma, allergic rhinitis, and
such later in life
● ITCH
● Reddish to brownish, dry, scaly,/cracked skin, mostly at night
● Tiny bumps on cheeks (infants)
● Rashes in folds of joints, scalp, back of hands (adults)
● Sleep deprivation from itchiness, employment loss, time to care,
and financial costs
● Heightened interest in determination of environmental risks and
potential factors
 Epidemiology ● Affects 1 in every 5 people
● Prevalence varies throughout the world
● Have risen by 2-4 folds over the past 40 years in industrialized
nations; lesser in agricultural nations
● Higher in urban areas
● Higher amongst those from higher social classes

Clinical Case: ➔ Patient was 3 years old at the time of investigation in 2021
Introduction of ➔ Male
the Patient ➔ Born August
➔ Lives in Guangzhou, Guangdong, China

Clinical Case: - Describe the essential nature of the complaint, including

Signs and location, intensity and associated symptoms
Symptoms In the first 3 months of the boy, he was fed infant milk powder, which
caused extreme itching of facial, neck and limb joints but also itching
around the eyes and occasionally tearing so that the infant scratched,
which resulted in skin bleeding and peeling. When consuming certain
food, the boy would feel extreme itching on his facial, scalp, and
periocular

Clinical Case: - Evolution of the complaint

Pathophysiology - Describe relieving and aggravating factors, including
responses to other treatment
- Health history, including family’s
- Result of examination
- Diagnosis
It was first recgnized when he was fed infant formula milk powder. For
abouy 7-8 hours the symtpoms perisisted. He was brought to a local
hospital, and he was diagnosed with AD. But after 3 months, he was fed
deeply hydrolyzed infant formula milk powder. Around the age of 1 year
and 6 motnhs, 21 allergens for the kid child were determined.

Clinical Case:
Prevention/Treat
ment Methods
REFERENCES

Contact dermatitis - Symptoms and causes - Mayo Clinic. (2023, April 25). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/contact-dermatitis/symptoms-causes/syc-
20352742

Dermatitis: Types and treatments — DermNet. (n.d.). https://dermnetnz.org/topics/dermatitis

Eczema and Dermatitis: Overview and more. (2023, February 23). Verywell Health.
https://www.verywellhealth.com/eczema-and-dermatitis-4013571

Eczema. (n.d.). https://www.singhealth.com.sg/patient-care/conditions-treatments/eczema

Faad, B. S. K. M. M. (n.d.). Atopic Dermatitis: practice Essentials, background,

pathophysiology. https://emedicine.medscape.com/article/1049085-overview

National Eczema Association. (2023, September 22). 7 Types of eczema: Symptoms, causes &
treatment. https://nationaleczema.org/eczema/types-of-eczema/

Wang, M., Liang, X., Sun, B., & Huang, H. (2021). Atopic Dermatitis: a Case Report of a
3-year-old Food Allergy Child Sensitive to Multiple Allergens. Research Square
(Research Square). https://doi.org/10.21203/rs.3.rs-146700/v1