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LETTER TO EDITOR
Year : 2000  |  Volume : 66  |  Issue : 4  |  Page : 218-219

Dermatoses Associated with Atopic Dermatitis (le)




Correspondence Address:
R R Mittal


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Source of Support: None, Conflict of Interest: None


PMID: 20877083

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How to cite this article:
Mittal R R, Walia R, Gill A K, Bansal N. Dermatoses Associated with Atopic Dermatitis (le). Indian J Dermatol Venereol Leprol 2000;66:218-9

How to cite this URL:
Mittal R R, Walia R, Gill A K, Bansal N. Dermatoses Associated with Atopic Dermatitis (le). Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2019 Sep 21];66:218-9. Available from: http://www.ijdvl.com/text.asp?2000/66/4/218/4928


To the Editor,

Atopic dermatitis (AD) is a chronically relapsing skin disorder of early infancy, childhood, adolescence and even adulthood, frequently associated with elevated serum IgE levels and a personal or family history of atopic disorders. Management of AD is a difficult proposition due to it being a life long process and multiple associations and complications. Moreover many dermatoses are frequently associated and contribute to its chronicity, severity through exacerbations and psychological stress. Infections i.e. bacterial, [1] fungal [2] and viral [3] are frequent in AD patients, being recurrent, chronic and widespread. Other dermatoses too are common like alopecia areata [4] drug reactions, pigmentary disorders etc.

A study of associated dermatoses in AD patients was conducted to know their management in AD. Out of 550 patients of AD studied over a period of 2 years at the Department of Dermato­Venereology, Rajindra Hospital, Patiala, 97 patients had one or more significant dermatoses. Fungal infections that are superficial mycoses, mostly re­current and chronic were present in 23/97 cases of AD and presented as tinea cruris in 10/23, tinea corporis in 6/23, tinea capitis in 3/23, tinea corporis with tinea cruris and tinea unguium in 1/23, tinea pedis with tinea unguium in 1/23, candidal intertrigo in 1/23 and otomycosis due to Aspergillus flavus in 1/23. Tinea corporis and tinea cruris took 8 weeks for cure with oral fluconazole and topical antifungals instead of usual 4 weeks required and others too needed longer periods of therapy. Bacterial infections were present in 33/97, were recurrent and presented as impetigo contagiosa in 12/33, furunculosis in 88/ 33, abscesses in 6/33, folliculitis in 4/33, carbuncles in 2/33 and cellulitis in 1/33, causative organisms mainly were staphylococci. Response to treatment was good but relapses were frequent. Viral infections were present in 15/97, as molluscum contagiosum in 6/15, warts in 4/15 and herpetic infections in 5/15 including a case presenting as eczema herpeticum. Response to treatment was moderate but recurrences were common. Pigmentary disurbances as hypo and hyperpigmentation were present. 6/97 had post inflammatory depigmentation, 4/97 had widespread hyperpigmentation which was uniform, dark brown and bilaterally symmetrical, 8/97 had cutaneous amyloidosis as macular amyloidosis in 6 and biphasic amyloidosis in 2 cases. Drug reactions (active) were present in 6/97 in the form of exaggeration of AD in 3, fixed drug eruptions in 2 and urticaria in 1, although many gave history of drug reactions earlier.

Alopecia areata was present in 5/97 cases including one presenting as ophiasis. Many other dermatoses were present i.e. seborrhoea capitis in 5/97, prurigo nodularis in 3/97, keloids in 2/97 and pityriasis versicolor, idiopathic urticaria, persistent dermographism, actinic prurigo, post herpetic neuralgia, maggots infestation, acne, naevus, seborrhoeic keratosis, necrobiosis lipoidica, delusional parasitosis, colloid milium, xanthelasma, hirsutism and pincer nail deformity were present in one case each.

Varied infections were associated mostly in cases of AD and as systemic steroids may precipitate/ aggravate these infections, minimum use of systemic and high potency topical steroids in AD patients is advocated. Other preventive easures like use of weak soaps i.e. having high total fat material (T F M.) followed by emollients, avoidance of excessive sun, wearing otton clothes, putting 1-2 crystals of potassium permanganate in bathing water, too help in better management. Hence arly diagnosis and treatment of associated dermatosis in AD patients and further prevention of recurrences alongwith encouragement will go a long way inmanaging AD.







 
  References Top

1.Champion RH, Parish WE. Atopic dermatitis, in: Textbook of Dermatology: 5th edition, edited by Champion RH, Burton JL, Ebling FIG, Blackwell Scientific Publications, Oxford, 1992; 1: 589-610.  Back to cited text no. 1    
2.Rystedt I. Atopic dermatitis: Review of the literature. Acta Derm Venereol 1985; Suppl. 117: 9-14.  Back to cited text no. 2    
3.Sehgal VN, Jain S. Atopic dermatitis: Clinical criteria. Int J Dermatol 1993; 32: 628-636.  Back to cited text no. 3  [PUBMED]  
4.Ikeda T A new classification of alopecia areata. Dermatologica 1968;131:421-445.  Back to cited text no. 4    




 

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