Atopic dermatitis differential diagnosis: Difference between revisions

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{{Atopic dermatitis}}
{{Atopic dermatitis}}


__NOTOC__
{{CMG}}; {{AE}} [[Ogechukwu Hannah Nnabude, MD]]; {{S.S}}
 
{{CMG}}; {{AE}}
==Overview==
==Overview==
Atopic dermatitis is a chronic [[inflammatory]] [[skin disorder]], which is indistinguishable from other [[causes]] of dermatitis. Atopic dermatitis is usually associated with personal or [[family history]] of [[atopic diseases]] including [[asthma]], [[allergic rhinitis]] and [[food allergy]]. The most common clinically similar dermatitis in infancy is [[seborrheic dermatitis]] which includes [[hyperkeratosis]] of the [[Scalp rash|scalp]], also found in atopic dermatitis.


==Differentiating Atopic Dermatitis from other Diseases==
==Atopic Dermatitis from other Diseases==
Atopic dermatitis should be differentiated from [[allergic contact dermatitis]], [[iirritant contact dermatitis]], [[seborrheic dermatitis]], [[psoriasis]], [[lichen simplex chronicus]], [[ichthyosis vulgaris]], [[nummular dermatitis (discoid eczema)]], [[netherton's syndrome]], and [[dermatitis herpetiformis]]
{|
{|
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
Line 14: Line 14:
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inherited
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inherited
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquired
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquired
! colspan="11" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestations
! colspan="9" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestations
! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
| colspan="2" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Associated factors'''
|-
|-
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated factors
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
|-
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Appearance
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Appearance
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Itching
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Itching
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Eosinophils
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum IgE  
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum IgE
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Single/
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Single/
Line 40: Line 38:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Involved areas
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Involved areas
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pustule
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pustule
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Platelets
|-
|-
! rowspan="10" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin disorders
! rowspan="10" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin disorders
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Atopic dermatitis
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atopic dermatitis]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Epidermal barrier dysfunction
*Epidermal barrier dysfunction
* Immune dysregulation
*[[Immune]] dysregulation
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Incidence is highest during infancy and early childhood.
*[[Incidence]] is highest during [[infancy]] and early childhood.
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |Multiple
* Family history of atopic dermatitis or other [[atopy]]
* Personal history of [[atopy]] ([[asthma]], [[allergic rhinitis]], [[food allergy]])
* Active and passive exposure to tobacco
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
*[[Erythema]], [[Exudate|exudates]], [[papules]],[[vesicles]], scales and crusts
*[[Erythema]], [[Exudate|exudates]], [[papules]],[[vesicles]], scales and crusts
* Infiltrated [[erythema]], [[prurigo]], scales and crusts
*Infiltrated [[erythema]], [[prurigo]], scales and crusts
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Young children -Scalp, cheeks amd extensor surface
*Young children -[[Scalp]], [[cheeks]] amd [[extensor]] surface
* Adolescents -flexural areas and buttock-thigh creases
*[[Adolescent|Adolescents]] -flexural areas and buttock-thigh creases
* Adults - facial involvement and skin flexures  
*Adults - facial involvement and skin flexures
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Centrofacial pallor
*Centrofacial pallor
* Delayed blanch response
*Delayed blanch response
* [[Keratosis pilaris]]
*[[Keratosis pilaris]]
* Palmar hyperlinearity
*Palmar hyperlinearity
* [[Pityriasis alba]]
*[[Pityriasis alba]]
* [[Ichthyosis]]
*[[Ichthyosis]]


* Infra-auricular and retro-auricular fissuring
*Infra-auricular and retro-auricular fissuring
* Nipple eczema
*Nipple [[eczema]]
* White dermographism
*White dermographism
* Perifollicular accentuation
*Perifollicular accentuation
| align="center" style="background:#F5F5F5;" | Nl to ↑
| align="center" style="background:#F5F5F5;" |Nl to ↑


(Eosinophilia)
([[Eosinophilia|Eosinophilia)]]
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Epidermal psoriasiform [[hyperplasia]]
*Epidermal psoriasiform [[hyperplasia]]
* Marked intercellular [[edema]] with spongiotic vesiculation
*Marked intercellular [[edema]] with spongiotic vesiculation


* [[Hyperkeratosis]]
*[[Hyperkeratosis]]
* Psoriasiform hyperplasia
*Psoriasiform [[hyperplasia]]
* Dyskeratosis
*Dyskeratosis
| align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Hayfever
*
* Asthma
*[[Family history]] of [[atopic dermatitis]] or other [[atopy]]
*Personal history of [[atopy]] ([[asthma]], [[allergic rhinitis]], [[food allergy]])
*Active and passive exposure to [[tobacco]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Allergic contact dermatitis]]<ref name="pmid19447733">{{cite journal |vauthors=Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF |title=Allergic and irritant contact dermatitis |journal=Eur J Dermatol |volume=19 |issue=4 |pages=325–32 |date=2009 |pmid=19447733 |doi=10.1684/ejd.2009.0686 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Allergic contact dermatitis]]<ref name="pmid19447733">{{cite journal |vauthors=Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF |title=Allergic and irritant contact dermatitis |journal=Eur J Dermatol |volume=19 |issue=4 |pages=325–32 |date=2009 |pmid=19447733 |doi=10.1684/ejd.2009.0686 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Delayed-type hypersensitivity response
*Delayed-type [[hypersensitivity]] response
* Skin inflammation mediated by hapten-specific T cells
*Skin [[inflammation]] mediated by [[Haptens|hapten]]-specific T cells
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Any
| align="center" style="background:#F5F5F5;" |Any
| align="center" style="background:#F5F5F5;" |
* Contact with allergens in the past 1-2 days
* Positive family history
| align="center" style="background:#F5F5F5;" |May be multiple after 1-2 days of exposure
| align="center" style="background:#F5F5F5;" |May be multiple after 1-2 days of exposure
| align="center" style="background:#F5F5F5;" | Erythematous well-demarcated papules
| align="center" style="background:#F5F5F5;" |Erythematous well-demarcated [[papules]]
| align="center" style="background:#F5F5F5;" | Surrounding the area in contact with the offending agent  
| align="center" style="background:#F5F5F5;" |Surrounding the area in contact with the offending agent
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Stinging and burning
*Stinging and burning
* Localized swelling
*Localized [[swelling]]
* Lichenified pruritic plaques
*[[Lichenification|Lichenified]] [[Itch|pruritic]] [[plaques]]
| align="center" style="background:#F5F5F5;" |Nl to ↑  
| align="center" style="background:#F5F5F5;" |Nl to ↑  
(Eosinophilia)
([[Eosinophilia]])
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Prevention by avoidance
*[[Eosinophilic]] spongiosis and [[microvesicles]]
*[[Exocytosis]] of [[eosinophils]] and [[lymphocytes]]
*Chronic - [[Hyperkeratosis]] and parakeratosis
| colspan="2" align="center" style="background:#F5F5F5;" |
*Contact with [[allergens]] in the past 1-2 days
*Positive [[family history]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Irritant contact dermatitis]]<ref name="pmid30293200">{{cite journal |vauthors=Bains SN, Nash P, Fonacier L |title=Irritant Contact Dermatitis |journal=Clin Rev Allergy Immunol |volume= |issue= |pages= |date=October 2018 |pmid=30293200 |doi=10.1007/s12016-018-8713-0 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Irritant contact dermatitis]]<ref name="pmid30293200">{{cite journal |vauthors=Bains SN, Nash P, Fonacier L |title=Irritant Contact Dermatitis |journal=Clin Rev Allergy Immunol |volume= |issue= |pages= |date=October 2018 |pmid=30293200 |doi=10.1007/s12016-018-8713-0 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Activation of the innate immune system by the pro-inflammatory properties of chemicals
*Activation of the [[innate immune system]] by the pro-[[inflammatory]] properties of chemicals
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Any, more occupational exposure  
| align="center" style="background:#F5F5F5;" |Any, more with occupational exposure
| align="center" style="background:#F5F5F5;" |
* Cumulative exposure to irritants
| align="center" style="background:#F5F5F5;" |Usually single immediately after the exposure
| align="center" style="background:#F5F5F5;" |Usually single immediately after the exposure
| align="center" style="background:#F5F5F5;" | Well-demarcated red patch with a glazed surface
| align="center" style="background:#F5F5F5;" |Well-demarcated red patch with a glazed surface
| align="center" style="background:#F5F5F5;" | Any area in contact with the irritant
| align="center" style="background:#F5F5F5;" |Any area in contact with the irritant
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Swelling, blistering and scaling of the damaged area
*[[Swelling]], [[Blister|blistering]] and scaling of the damaged area
* Dryness
*Dryness
* Thicker skin
*Thicker skin
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Spongiosis
*Spongiosis
* Intraepidermal vesicles or bullae
*Intraepidermal [[vesicles]] or bullae
* Necrosis of keratinocytes
*[[Necrosis]] of [[keratinocytes]]
| align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Negative hypersensitivity tests
*Cumulative exposure to [[irritants]]
*Negative hypersensitivity tests
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seborrheic dermatitis]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seborrheic dermatitis]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Unknown
*Not known
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any, onset during the 1st days or weeks of life
| align="center" style="background:#F5F5F5;" |Any, onset during the infancy and peak during 3rd-4th decades
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Stress
*[[Cradle cap]] - yellowish scales on the [[Scalp rash|scalp]]
*Patchy or diffuse greasy scaling with or without a yellow-red base
*Crusts
| align="center" style="background:#F5F5F5;" |Scalp, face, trunk, postauricular, diaper area and axilla
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
*Infants:
**[[Cradle cap]] (Sclap) - non-inflammatory greasy scales on the scalp
**Asymptomatic
**Self resolving
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
*Focal parakeratosis and spongiosis in epidermis
*Psoriasiform [[hyperplasia]]
*[[Neutrophils]] at the margins
| colspan="2" align="center" style="background:#F5F5F5;" |Risk factors include
 
*[[Stress]]
 
*Cold, dry weather can cause flare ups
*[[Superinfection]] with bacteria and [[candida]]


* Cold, dry weather
Generalized seborrheic [[erythroderma]] in immunodeficient patients
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" | Greasy scaling on a yellow-red base
| align="center" style="background:#F5F5F5;" | Scalp, axilla, and diaper area
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Psoriasis]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Psoriasis]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Keratinocyte hyperproliferation
*[[Keratinocyte]] hyperproliferation
* Dysregulation of the immune system
*Dysregulation of the [[immune system]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any, 2 peaks of onset 30-39 years and 50-59 years
| align="center" style="background:#F5F5F5;" |Any, 2 peaks of onset 30-39 years and 50-59 years
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |Well-circumscribed, pink [[papules]] and symmetrically distributed cutaneous [[plaques]] with silvery scales
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Smoking
*Scalp
* Skin trauma
*Trunk
* Alcohol abuse
*Gluteal cleft
* Stress
*Extensor surface of elbows and knees
* Cold weather
* Vitamin D deficiency
* Drugs
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" | Well-circumscribed, pink papules and symmetrically distributed cutaneous plaques with silvery scales
| align="center" style="background:#F5F5F5;" |
* Scalp
* Trunk
* Gluteal cleft
* Extensor surface of elbows and knees
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |_
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
*[[Auspitz's sign]]  (pinpoint bleeding)
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
*[[Epidermal]] [[hyperplasia]]
*Parakeratosis
*[[Neutrophils]] microabscesses (Munro microabscesses)
| colspan="2" align="center" style="background:#F5F5F5;" |Risk factors include


Auspitz sign
*[[Smoking]]
 
*Skin trauma
(pinpoint bleeding)
*[[Alcohol abuse]]
| align="center" style="background:#F5F5F5;" | _
*[[Stress]]
| align="center" style="background:#F5F5F5;" | +
*Cold weather
| align="center" style="background:#F5F5F5;" |
*Vitamin D deficiency
* Auspitz sign  (pinpoint bleeding)
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
|-
! align="center" style="background:#DCDCDC;" |[[Lichen simplex chronicus|Lichen simplex]] <ref name="pmid28785363">{{cite journal |vauthors=Voicu C, Tebeica T, Zanardelli M, Mangarov H, Lotti T, Wollina U, Lotti J, França K, Batashki A, Tchernev G |title=Lichen Simplex Chronicus as an Essential Part of the Dermatologic Masquerade |journal=Open Access Maced J Med Sci |volume=5 |issue=4 |pages=556–557 |date=July 2017 |pmid=28785363 |pmc=5535688 |doi=10.3889/oamjms.2017.133 |url=}}</ref>[[Lichen simplex chronicus|chronicus]]
! align="center" style="background:#DCDCDC;" |[[Lichen simplex chronicus|Lichen simplex]] <ref name="pmid28785363">{{cite journal |vauthors=Voicu C, Tebeica T, Zanardelli M, Mangarov H, Lotti T, Wollina U, Lotti J, França K, Batashki A, Tchernev G |title=Lichen Simplex Chronicus as an Essential Part of the Dermatologic Masquerade |journal=Open Access Maced J Med Sci |volume=5 |issue=4 |pages=556–557 |date=July 2017 |pmid=28785363 |pmc=5535688 |doi=10.3889/oamjms.2017.133 |url=}}</ref>[[Lichen simplex chronicus|chronicus]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Lichenified plaques  and excoriations of lichen simplex chronicus develop secondary to extensive pruritus due to other conditions such as atopic dermatitis, neuropathic pruritus, etc
*Secondary to extensive [[pruritus]] due to other conditions such as [[Atopic dermatitis|atopic dermatitis,]] neuropathic pruritus, etc
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any, peak at 30-50 years of age
| align="center" style="background:#F5F5F5;" |Any, peak at 30-50 years of age
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |Multiple
* Emotional stress
| align="center" style="background:#F5F5F5;" |[[Lichenification|Lichenified]] and [[erythematous]], [[Itch|pruritic]] [[exudative]] [[Plaques|plaque]], and excoriations
* Sleep disturbances
| align="center" style="background:#F5F5F5;" |Scalp, head, neck, hands, arms, and genitals areas
* Dry weather
| align="center" style="background:#F5F5F5;" |–
* Sweating
* Excessive dryness
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" | Lichenified and erythematous, pruritic exudative plaque, and excoriations
| align="center" style="background:#F5F5F5;" | Scalp, head, neck, hands, arms, and genitals areas
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Color of plaque varies fro, yellow to reddish brown  
*Color of [[Plaques|plaque]] varies from yellow to reddish-brown
* Plaque size can vary between 3X6 cm 6X10 cm areas.
*[[Plaque]] size can vary between 3X6 cm 6X10 cm areas.
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Markedly hyperplastic epidermis  
*Markedly [[Hyperplasia|hyperplastic]] [[epidermis]]
* Irregular hyperkeratosis and parakeratosis  
*Irregular [[hyperkeratosis]] and parakeratosis
* Thick granular zone
*Thick granular zone
* Acanthosis  
*[[Acanthosis]]
| align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |Risk factors include
* Sexual dysfunction
 
* Sleep disturbances
*[[Emotional stress]]
* Depression
*Dry weather
* Dissociative disturbances
*[[Sweating]]
*[[Sexual dysfunction]]
*[[Sleep disturbances]]
*[[Depression]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Ichthyosis vulgaris]]<ref name="pmid23301728">{{cite journal |vauthors=Thyssen JP, Godoy-Gijon E, Elias PM |title=Ichthyosis vulgaris: the filaggrin mutation disease |journal=Br. J. Dermatol. |volume=168 |issue=6 |pages=1155–66 |date=June 2013 |pmid=23301728 |doi=10.1111/bjd.12219 |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Ichthyosis vulgaris]]<ref name="pmid23301728">{{cite journal |vauthors=Thyssen JP, Godoy-Gijon E, Elias PM |title=Ichthyosis vulgaris: the filaggrin mutation disease |journal=Br. J. Dermatol. |volume=168 |issue=6 |pages=1155–66 |date=June 2013 |pmid=23301728 |doi=10.1111/bjd.12219 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Loss of function mutations in the filaggrin gene (''FLG'')
*Loss of function [[mutations]] in the [[Filaggrin|filaggrin gene (''FLG'')]]
* Autosomal dominant inheritance with incomplete penetrance
*[[Autosomal dominant inheritance]] with [[incomplete penetrance]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Usually in infancy
| align="center" style="background:#F5F5F5;" |Usually in infancy
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Dry and cold weather
*[[Xerosis]] and gray [[Ichthyosis|scaling]]
* Increased risk of atopic diseases including asthma, alllergic rhinitis and atopic dermatitis
*[[Palmar]] hyperlinearity
| align="center" style="background:#F5F5F5;" | Multiple
*[[Keratosis pilaris]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Xerosis and gray scaling
*Extensor surfaces of the extremities
* Palmar hyperlinearity
*Scalp
* Keratosis pilaris
*Trunk
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |–
* Extensor surfaces of the extremities
| align="center" style="background:#F5F5F5;" |–
* Scalp
| align="center" style="background:#F5F5F5;" |–
* Trunk
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Scales can vary from mild scaling to large, plate (armor)-like scales and thickening of the skin.
*Scales can vary from mild scaling to large, plate (armor)-like scales and thickening of the skin.
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Reduced keratohyalin granules  
*Reduced keratohyalin [[granules]]
* Perinuclear keratin retractions in granular cells
*[[Perinuclear space|Perinuclear]] [[keratin]] retractions in [[Granule cell|granular]] cells
* Thick stratum corneum  
*Thick [[stratum corneum]]
* Basket-weave pattern of stratum corneum
*Basket-weave pattern of [[stratum corneum]]
| align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Increased risk for atopy, including asthma, allergies, and atopic dermatitis
*Increased risk of [[atopic diseases]] including [[asthma]], alllergic rhinitis and [[atopic dermatitis]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Nummular dermatitis|Nummular dermatitis (discoid eczema)]]
! align="center" style="background:#DCDCDC;" |[[Nummular dermatitis|Nummular dermatitis (discoid eczema)]]
| align="center" style="background:#F5F5F5;" | Unknown
| align="center" style="background:#F5F5F5;" |Unknown
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any,  two peaks, 6th-7th  decade of life in males and 2nd-3rd decade of life in females
| align="center" style="background:#F5F5F5;" |Any,  two peaks, 6th-7th  decade of life in males and 2nd-3rd decade of life in females
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Temperature changes (particularly winter)
*Symmetrical  coin-shaped [[Erythematous rash|erythematous]] [[plaques]]
* Emotional stress
*Erosions and excoriations
* Dry skin
*Chronic lesions- central clearing leading to annular lesions
* Environmental irritants
* Recent surgery
* Medications like topical antibiotic creams and isotretinoin
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Upper extremities
*Upper and lower extremities
* Lower extremities
*Lower trunk
* Lower trunk
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Chronically lesions result into central clearing leading to annular lesions.
*Chronically [[lesions]] result into central clearing leading to annular lesions.
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Spongiosis
*Spongiosis
* Perivascular lymphocytic infiltrates, with eosinophils and occasional neutrophils
*[[Perivascular cell|Perivascular]] [[lymphocytic]] infiltrates, with [[eosinophils]] and occasional [[neutrophils]]
| align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Superinfection with ''staphylococcus aureus''
*Risk factors include
*
**Temperature changes (particularly winter)
**[[Emotional stress]]
**[[Dry skin]]
**Environmental irritants
**Recent [[surgery]]
**Medications like [[topical]] antibiotic creams and [[isotretinoin]]
*[[Superinfection]] with ''[[staphylococcus aureus]]''
|-
|-
! align="center" style="background:#DCDCDC;" |[[Netherton's syndrome]]<ref name="pmid10835624">{{cite journal |vauthors=Chavanas S, Bodemer C, Rochat A, Hamel-Teillac D, Ali M, Irvine AD, Bonafé JL, Wilkinson J, Taïeb A, Barrandon Y, Harper JI, de Prost Y, Hovnanian A |title=Mutations in SPINK5, encoding a serine protease inhibitor, cause Netherton syndrome |journal=Nat. Genet. |volume=25 |issue=2 |pages=141–2 |date=June 2000 |pmid=10835624 |doi=10.1038/75977 |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Netherton's syndrome]]<ref name="pmid10835624">{{cite journal |vauthors=Chavanas S, Bodemer C, Rochat A, Hamel-Teillac D, Ali M, Irvine AD, Bonafé JL, Wilkinson J, Taïeb A, Barrandon Y, Harper JI, de Prost Y, Hovnanian A |title=Mutations in SPINK5, encoding a serine protease inhibitor, cause Netherton syndrome |journal=Nat. Genet. |volume=25 |issue=2 |pages=141–2 |date=June 2000 |pmid=10835624 |doi=10.1038/75977 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | Autosomal recessive mutations in the serine protease inhibitor of Kazal type 5 gene (''SPINK5), encoding LEKTI'', a serine protease inhibitor
| align="center" style="background:#F5F5F5;" |[[Autosomal recessive]] [[mutations]] in the [[SPINK5|serine protease inhibitor of Kazal type 5 gene (''SPINK5)'']]'', encoding [[LEKTI]]''[[LEKTI|, a serine protease inhibitor]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | Affects neonates
| align="center" style="background:#F5F5F5;" |Affects [[neonates]]
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Atopic diseases including food allergy and strong family history of asthma, atopic dermatitis and allergic rhinitis
*Classic triad
| align="center" style="background:#F5F5F5;" | Multiple
**Congenital ichthyosiform erythroderma
**Trichorrhexis invaginata
**[[Atopy|Allergic diseases]] with ↑ serum [[IgE]] levels
*Ichthyosis linearis circumflexa (ILC) - [[serpiginous]] [[plaques]] with double scale at the margins
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Classic triad
*Diffuse pattern
** Congenital ichthyosiform erythroderma
*Axillae,
** Trichorrhexis invaginata
*Hair
** Allergic diseases with elevated serum levels of immunoglobulin
*Inguinal folds
* Ichthyosis linearis circumflexa (ILC) - serpiginous migratory pink-red plaques with double-edged scale at the margins
*Gluteal cleft
| align="center" style="background:#F5F5F5;" |
*Groin
* Diffuse pattern
*Lower legs
* Axillae,
* Hair
* Inguinal folds
* Gluteal cleft  
* Groin
* Lower legs  
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Trichorrhexis invaginata (hair involvement):
*Trichorrhexis invaginata (hair involvement):
** Sparse, short, spike and brittle
**Sparse, short, spike and brittle
** "Bamboo hair" or "ball and socket deformity" of hair and eyebrows
**"Bamboo hair" or "ball and socket deformity" of hair and eyebrows
** Nodes along the hair shaft
**Nodes along the hair shaft
| align="center" style="background:#F5F5F5;" |Nl to ↑
| align="center" style="background:#F5F5F5;" |Nl to ↑


(Eosinophilia)
([[Eosinophilia]])
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" | ↑  
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* psoriasiform hyperplasia
*Psoriasiform [[hyperplasia]]
* Reduced granular layer
*Reduced granular layer
* Dyskeratosis,
*Dyskeratosis
* Dermal inflammatory infiltrate including neutrophils and eosinophils
*[[Dermal]] [[inflammatory]] infiltrate including [[neutrophils]] and [[eosinophils]]
| align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
** Systemic and skin superinfections  
*[[Atopic diseases]] including asthma, [[atopic dermatitis]] and [[allergic rhinitis]]
** Failure to thrive  
*Systemic and skin superinfections
** Electrolyte imbalances, including hypernatremic dehydration
*[[Failure to thrive]]
** Atopic diseases
*Electrolyte imbalances, including [[hypernatremia]],[[dehydration]]
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
Line 383: Line 363:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquired
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquired
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated factors
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Single/
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Single/
Multiple
Multiple
Line 390: Line 369:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pustule
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pustule
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Itching
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Itching
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Platelets
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum IgE
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |ESR/CRP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated factors
|-
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infection
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Dermatophyte|Dermatophytes]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infection
! align="center" style="background:#DCDCDC;" |[[Molluscum contagiosum]]
! align="center" style="background:#DCDCDC;" |[[Molluscum contagiosum]]
| align="center" style="background:#F5F5F5;" | Molluscum contagiosum virus inoculation through direct skin contact
| align="center" style="background:#F5F5F5;" |[[Molluscum contagiosum]] virus [[inoculation]] through direct skin contact
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any, peak among children >5 years of age and young adults
| align="center" style="background:#F5F5F5;" |Any, peak among children >5 years of age and young adults
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Often asymptomatic
*Flesh-colored, dome-shaped [[papules]] with a central umbilication
* Tender or pruritic skin lesions
*Lesions are 2-5mm in diameter
* Self resolve within 2 months
* Immunocompetent patients present with extensive and severe infections
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Flesh-colored, dome-shaped papules with a central umbilication
*Face, trunk, [[Antecubital fossa|antecubital]][[Popliteal fossa|popliteal fossae]] and groin
* Lesions are 2-5mm in diameter
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
* Face, trunk, antecubital,  popliteal fossae and groin
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |If [[molluscum contagiosum]] is acquired as [[sexually transmitted disease]], it involves, groin and genital region.
| align="center" style="background:#F5F5F5;" | If molluscum contagiosum is acquired as sexually transmitted disease, it involves, groin and genital region.  
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Keratinocytes containing eosinophilic inclusion bodies (Henderson-Paterson bodies)
*[[Keratinocytes]] containing [[eosinophilic]] [[inclusion bodies]] (Henderson-Paterson bodies)
* H&E stain - inwards indentation of the epidermis  
*[[H&E stain]] - inwards indentation of the [[epidermis]]
| align="center" style="background:#F5F5F5;" | mMlluscum contagiosum
| colspan="2" align="center" style="background:#F5F5F5;" |
 
*Often [[asymptomatic]]
lesions on the eyelid may lead to follicular or papillary conjunctivitis .
*Self resolve within 2 months
|-
*Immunodeficient patients present with extensive and severe infections
! align="center" style="background:#DCDCDC;" |[[Scabies]]
*[[Molluscum contagiosum]]  lesions on the [[eyelid]] may lead to follicular or papillary [[conjunctivitis]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Positive family history
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" | Erythematous papular lesions
| align="center" style="background:#F5F5F5;" | Flexor wrists, finger webs and genitalia
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" | +++
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inherited
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquired
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated factors
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Single/
Multiple
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Rash
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Involved areas
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pustule
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Itching
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Platelets
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |ESR/CRP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunologic disorders
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunologic disorders
! align="center" style="background:#DCDCDC;" |[[Dermatitis herpetiformis]]<ref name="pmid22137227">{{cite journal |vauthors=Kárpáti S |title=Dermatitis herpetiformis |journal=Clin. Dermatol. |volume=30 |issue=1 |pages=56–9 |date=2012 |pmid=22137227 |doi=10.1016/j.clindermatol.2011.03.010 |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Dermatitis herpetiformis]]<ref name="pmid22137227">{{cite journal |vauthors=Kárpáti S |title=Dermatitis herpetiformis |journal=Clin. Dermatol. |volume=30 |issue=1 |pages=56–9 |date=2012 |pmid=22137227 |doi=10.1016/j.clindermatol.2011.03.010 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | Autoimmune disorder as a result of gluten sensitivity leading to the formation of IgA antibodies
| align="center" style="background:#F5F5F5;" |[[Autoimmunity|Autoimmune]] disorder as a result of [[gluten sensitivity]] leading to the formation of [[IgA]] antibodies
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any, mean age of disease onset is 2nd-4th decade
| align="center" style="background:#F5F5F5;" |Any, mean age of disease onset is 2nd-4th decade
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Intermittent pruritic papules and vesicles
*Excoriated [[papules]], [[plaques]] and [[vesicles]] arranged in a clustered fashion
* Associated small intestine celiac disease with villous atrophy and crypt hyperplasia
*Symmetrical
| align="center" style="background:#F5F5F5;" | Multiple
*Erosions and excoriations
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Excoriated papules or plaques and vesicles arranged in a clustered fashion
*Extensor surfaces including arms, knees, and buttocks.
* Symmetrical
| align="center" style="background:#F5F5F5;" |–
* Erosions and excoriations
| align="center" style="background:#F5F5F5;" |
* Extensor surfaces including arms, knees, and buttocks.
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Oral manifestation such as vesicles and erosion may be present
*Oral manifestation such as [[vesicles]] and erosion may be present
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Papillary micro-abscesses
*[[Papillary]] micro-[[abscesses]]
* Sub-epidermal blisters containing neutrophils, eosinophils, and fibrin  
*Sub-epidermal [[blisters]] containing [[neutrophils]], [[eosinophils]], and [[fibrin]]
* Sub-epidermal vacuolization  
*Sub-epidermal [[vacuolization]]
| align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Abdominal bloating, pain, diarrhea, or constipation
*Intermittent [[Itch|pruritic]] [[papules]] and [[vesicles]]
*[[Celiac disease]] with [[Villous folds|villous]] atrophy and [[Crypt (anatomy)|crypt]] [[hyperplasia]]
*Abdominal [[bloating]], pain, [[Diarrheal|diarrhea]], or [[constipation]]
|-
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immune deficiency
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immune deficiency
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wiskott-Aldrich syndrome]]<ref name="pmid24817816">{{cite journal |vauthors=Buchbinder D, Nugent DJ, Fillipovich AH |title=Wiskott-Aldrich syndrome: diagnosis, current management, and emerging treatments |journal=Appl Clin Genet |volume=7 |issue= |pages=55–66 |date=2014 |pmid=24817816 |pmc=4012343 |doi=10.2147/TACG.S58444 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wiskott-Aldrich syndrome]]<ref name="pmid24817816">{{cite journal |vauthors=Buchbinder D, Nugent DJ, Fillipovich AH |title=Wiskott-Aldrich syndrome: diagnosis, current management, and emerging treatments |journal=Appl Clin Genet |volume=7 |issue= |pages=55–66 |date=2014 |pmid=24817816 |pmc=4012343 |doi=10.2147/TACG.S58444 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Mutation in the gene encoding for Wiskott-Aldrich syndrome protein (WASp) on the short arm of the X chromosome
*Mutation in the gene encoding for [[Wiskott-Aldrich syndrome]] protein (WASp) on the short arm of the [[X chromosome]]
* X-linked disorder
*[[X linked inheritance|X-linked disorder]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | Seen almost exclusively in males in infancy
| align="center" style="background:#F5F5F5;" |Seen almost exclusively in males in infancy
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Blleeding: severe thrombocytopenia,
*Rash is clinically similar to [[atopic dermatitis]]
* Eczema - similar to atopic dermatitis
*[[Erythematous]] and [[Itch|pruritic]] lesions
* Recurrent sino-pulmonary infections
*Lesions can bleed due to [[thrombocytopenia]]
* Opportunistic infections.
*Cutaneous manifestations includes [[Petechia|petechiae]] and [[ecchymosis]]
* Autoimmune diseases
| align="center" style="background:#F5F5F5;" |Rash can involve lesions located at the same areas of classical atopic dermatitis:
* Malignancies
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |
* Rash is clinically similar to atopic dermatitis
* Erythematous and pruritic lesions
* Lesions can bleed due to thrombocytopenia
* Cutaneous manifestations includes petechiae and ecchymosis
| align="center" style="background:#F5F5F5;" | Rash can involve lesions located at the same areas of classical atopic dermatitis:


extensor surfaces of extremities and cheeks or scalp
extensor surfaces of extremities and cheeks or scalp
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |Infants can present with [[petechiae]], prolonged [[bleeding]] from [[umbilicus]] or circumcision,  [[purpura]],[[hematemesis]], [[melena]], [[epistaxis]], [[hematuria]] or unusal bruising
| align="center" style="background:#F5F5F5;" | Infants can present with petechiae, prolonged bleeding from umbilicus or circumcision,  purpura, hematemesis, melena, epistaxis, hematuria  or unusal bruising
| align="center" style="background:#F5F5F5;" |Nl to ↑
| align="center" style="background:#F5F5F5;" |Nl to ↑


(Eosinophilia)
([[Eosinophilia]])
 
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" | Thrombocytopenia
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Hyperkeratosis]]
*[[Hyperkeratosis]]
* Psoriasiform hyperplasia
*Psoriasiform [[hyperplasia]]
* Dyskeratosis
*Dyskeratosis


* Epidermal psoriasiform [[hyperplasia]]
*Epidermal psoriasiform [[hyperplasia]]
* Marked intercellular [[edema]] with spongiotic vesiculation
*Marked intercellular [[edema]] with spongiotic vesiculation
| align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* ↑ serum immunoglobulin A (IgA) levels
*↑ serum [[IgA]] levels
* ↑ serum immunoglobulin E (IgE) levels
*↑ serum [[IgE]] levels
*Bleeding: severe [[thrombocytopenia]],
*[[Eczema]] - similar to [[atopic dermatitis]]
*Recurrent sino-pulmonary infections
*[[Opportunistic infection|Opportunistic infections.]]
*[[Autoimmune diseases]]
*[[Malignancies]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hyper-IgE syndrome]]<ref name="pmid24058807">{{cite journal |vauthors=Mogensen TH |title=STAT3 and the Hyper-IgE syndrome: Clinical presentation, genetic origin, pathogenesis, novel findings and remaining uncertainties |journal=JAKSTAT |volume=2 |issue=2 |pages=e23435 |date=April 2013 |pmid=24058807 |pmc=3710320 |doi=10.4161/jkst.23435 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hyper-IgE syndrome]]<ref name="pmid24058807">{{cite journal |vauthors=Mogensen TH |title=STAT3 and the Hyper-IgE syndrome: Clinical presentation, genetic origin, pathogenesis, novel findings and remaining uncertainties |journal=JAKSTAT |volume=2 |issue=2 |pages=e23435 |date=April 2013 |pmid=24058807 |pmc=3710320 |doi=10.4161/jkst.23435 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Defects in the JAK-STAT signaling pathway leading to dysfunctional T helper cell type 17 (Th17) differentiation
*Defects in the [[JAK-STAT signaling pathway]] leading to dysfunctional [[T helper cell]] type 17 ([[T helper 17 cell|Th17]]) [[differentiation]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | Rare, begin in infancy  
| align="center" style="background:#F5F5F5;" |Rare, begin in infancy
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |Multiple
* Cold abscesses
 
* Pruritic eczema
* Allergic diseases
* Noneruption of permanent teeth
* Multiple bone fractures and scoliosisis
* Peripheral T-cell lymphoma
* Coronary artery aneurysms
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Papulopustular
*Papulopustular
* Severely pruritic eczematous rash  
*Severely [[Itch|pruritic]] eczematous rash
* Pustular and may impetiginized
*[[Pustular rash|Pustular]] and may impetiginized
* Lichenification may occur
*[[Lichenification]] may occur
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Face and scalp
*Face and scalp
* Upper trunk and shoulders  
*Upper trunk and shoulders
* Buttocks
*Buttocks
* Area behind the ears and around the hairline
*Area behind the ears and around the hairline
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Characteristic coarse facies
*Characteristic coarse facies
* Increased alar width and broad nasal bridge
*Increased alar width and broad [[nasal bridge]]
* High-arched oral palate
*High-arched oral palate
* Hyperextensible joints  
*Hyperextensible joints
| align="center" style="background:#F5F5F5;" |Nl to ↑
| align="center" style="background:#F5F5F5;" |Nl to ↑


(Eosinophilia)
([[Eosinophilia]])
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" | ↑  
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Eosinophil-rich infiltration around the hair follicles
*[[Eosinophil]]-rich infiltration around the hair follicles
| align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
*  
*Cold [[abscesses]]
 
*[[Itch|Pruritic]] [[eczema]]
*[[Allergy|Allergic]] diseases
*Noneruption of permanent teeth
*Multiple bone [[Bone fracture|fractures]] and scoliosisis
*[[Peripheral T-cell lymphomas|Peripheral T-cell lymphoma]]
*[[Coronary artery]] [[aneurysms]]
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Malignancy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Malignancy
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mycosis fungoides]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mycosis fungoides]]
| align="center" style="background:#F5F5F5;" | Clonal expansion of CD4<sup>+</sup> memory T cells (CD45RO<sup>+</sup>)
| align="center" style="background:#F5F5F5;" |Clonal expansion of [[CD4+ cell|CD4]]<sup>+</sup> [[memory T cells]] (CD45RO<sup>+</sup>)
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Mean age is  55- 60 years
| align="center" style="background:#F5F5F5;" |Mean age is  55- 60 years
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Increased risk of :
*Non-pruritic patches and intensely [[Itch|pruritic]] [[plaques]]
** Severe viral and bacterial infections
*[[Comedones]], [[cysts]]
** Secondary malignancies, especially lymphomas
*[[Tumors]] of skin
 
*[[Erythematous]] [[macules]]
| align="center" style="background:#F5F5F5;" | Multiple
*[[Hypopigmented area|Hypopigmented]] patches
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Non pruritic patches and intensely pruritic plaques
*Asymmetrical
* Comedones, cysts
*Hips, groin and trunk
* Tumors of skin
| align="center" style="background:#F5F5F5;" |–
* Erythematous macules
* Hypopigmented patches
| align="center" style="background:#F5F5F5;" |
* Asymmetrical
* Hips, groin and trunk
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Alopecia
*[[Alopecia]]
* Acneiform lesions
*[[Acneiform eruption|Acneiform]] lesions
* Plaques size can vary between 2-20 cm
*[[Plaques]] size can vary between 2-20 cm
* Lymphadenopathy
*[[Lymphadenopathy]]
* Children-  hypopigmented patches most common
*Children-  [[Hypopigmentation|hypopigmented]] patches most common
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |
* Perifollicular infiltrates around the infundibulum
* Epidermis is spared or has minimal spongiosis
* Band-like dermal infiltrate of lymphocytes and and histiocytes
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Staging of Mycosis fungoides is based upon:
*Perifollicular infiltrates around the [[infundibulum]]
** Patches
*[[Epidermis]] is spared or has minimal spongiosis
** Plaques
*Band-like [[Dermal|derma]]<nowiki/>l infiltrate of [[lymphocytes]] and and [[histiocytes]]
** Skin tumors
| colspan="2" align="center" style="background:#F5F5F5;" |
** Lymphadenopathy
*Increased risk of :
** Erythroderma
**Severe viral and bacterial infections
** Histology
**Secondary [[malignancies]], especially lymphomas
|-
*Staging of [[Mycosis fungoides]] is based upon:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
**Patches
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
**[[Plaques]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
**Skin tumors
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inherited
**[[Lymphadenopathy]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquired
**[[Erythroderma]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
**[[Histology]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated factors
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Single/
Multiple
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Rash
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Involved areas
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pustule
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Itching
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Platelets
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |ESR/CRP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|}
|}


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[[Category:Autoimmune diseases]]
[[Category:Autoimmune diseases]]
[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Needs content]]
[[Category:Primary care]]
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Latest revision as of 02:44, 16 October 2021

Atopic dermatitis Microchapters

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Risk calculators and risk factors forAtopic dermatitis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD; Shalinder Singh, M.B.B.S.[2]

Overview

Atopic dermatitis is a chronic inflammatory skin disorder, which is indistinguishable from other causes of dermatitis. Atopic dermatitis is usually associated with personal or family history of atopic diseases including asthma, allergic rhinitis and food allergy. The most common clinically similar dermatitis in infancy is seborrheic dermatitis which includes hyperkeratosis of the scalp, also found in atopic dermatitis.

Atopic Dermatitis from other Diseases

Atopic dermatitis should be differentiated from allergic contact dermatitis, iirritant contact dermatitis, seborrheic dermatitis, psoriasis, lichen simplex chronicus, ichthyosis vulgaris, nummular dermatitis (discoid eczema), netherton's syndrome, and dermatitis herpetiformis

Category Diseases Etiology Inherited Acquired Clinical manifestations Para-clinical findings Associated factors
Demography Symptoms Physical examination
Lab Findings Histopathology
Appearance Itching Fever Tenderness Other Eosinophils Serum IgE
Single/

Multiple

Rash Involved areas Pustule
Skin disorders Atopic dermatitis
  • Epidermal barrier dysfunction
  • Immune dysregulation
+ + Multiple
  • Young children -Scalp, cheeks amd extensor surface
  • Adolescents -flexural areas and buttock-thigh creases
  • Adults - facial involvement and skin flexures
+
  • Infra-auricular and retro-auricular fissuring
  • Nipple eczema
  • White dermographism
  • Perifollicular accentuation
Nl to ↑

(Eosinophilia)

  • Epidermal psoriasiform hyperplasia
  • Marked intercellular edema with spongiotic vesiculation
Allergic contact dermatitis[1] + Any May be multiple after 1-2 days of exposure Erythematous well-demarcated papules Surrounding the area in contact with the offending agent + + Nl to ↑

(Eosinophilia)

Nl
Irritant contact dermatitis[2] + Any, more with occupational exposure Usually single immediately after the exposure Well-demarcated red patch with a glazed surface Any area in contact with the irritant + + Nl Nl
  • Cumulative exposure to irritants
  • Negative hypersensitivity tests
Seborrheic dermatitis
  • Not known
+ Any, onset during the infancy and peak during 3rd-4th decades Multiple
  • Cradle cap - yellowish scales on the scalp
  • Patchy or diffuse greasy scaling with or without a yellow-red base
  • Crusts
Scalp, face, trunk, postauricular, diaper area and axilla + +
  • Infants:
    • Cradle cap (Sclap) - non-inflammatory greasy scales on the scalp
    • Asymptomatic
    • Self resolving
Nl Nl Risk factors include

Generalized seborrheic erythroderma in immunodeficient patients

Psoriasis + + Any, 2 peaks of onset 30-39 years and 50-59 years Multiple Well-circumscribed, pink papules and symmetrically distributed cutaneous plaques with silvery scales
  • Scalp
  • Trunk
  • Gluteal cleft
  • Extensor surface of elbows and knees
+ + _ + Nl Nl Risk factors include
Lichen simplex [3]chronicus + Any, peak at 30-50 years of age Multiple Lichenified and erythematous, pruritic exudative plaque, and excoriations Scalp, head, neck, hands, arms, and genitals areas +
  • Color of plaque varies from yellow to reddish-brown
  • Plaque size can vary between 3X6 cm 6X10 cm areas.
Nl Nl Risk factors include
Ichthyosis vulgaris[4] + + Usually in infancy Multiple
  • Extensor surfaces of the extremities
  • Scalp
  • Trunk
  • Scales can vary from mild scaling to large, plate (armor)-like scales and thickening of the skin.
Nl Nl
Nummular dermatitis (discoid eczema) Unknown + Any, two peaks, 6th-7th decade of life in males and 2nd-3rd decade of life in females Multiple
  • Symmetrical coin-shaped erythematous plaques
  • Erosions and excoriations
  • Chronic lesions- central clearing leading to annular lesions
  • Upper and lower extremities
  • Lower trunk
+
  • Chronically lesions result into central clearing leading to annular lesions.
Nl Nl
Netherton's syndrome[5] Autosomal recessive mutations in the serine protease inhibitor of Kazal type 5 gene (SPINK5), encoding LEKTI, a serine protease inhibitor + Affects neonates Multiple
  • Classic triad
    • Congenital ichthyosiform erythroderma
    • Trichorrhexis invaginata
    • Allergic diseases with ↑ serum IgE levels
  • Ichthyosis linearis circumflexa (ILC) - serpiginous plaques with double scale at the margins
  • Diffuse pattern
  • Axillae,
  • Hair
  • Inguinal folds
  • Gluteal cleft
  • Groin
  • Lower legs
+ +
  • Trichorrhexis invaginata (hair involvement):
    • Sparse, short, spike and brittle
    • "Bamboo hair" or "ball and socket deformity" of hair and eyebrows
    • Nodes along the hair shaft
Nl to ↑

(Eosinophilia)

Diseases Etiology Inherited Acquired Demography Single/

Multiple

Rash Involved areas Pustule Itching Fever Tenderness Other WBC Serum IgE Histopathology Associated factors
Infection Molluscum contagiosum Molluscum contagiosum virus inoculation through direct skin contact + Any, peak among children >5 years of age and young adults Multiple
  • Flesh-colored, dome-shaped papules with a central umbilication
  • Lesions are 2-5mm in diameter
+ If molluscum contagiosum is acquired as sexually transmitted disease, it involves, groin and genital region. Nl Nl
Immunologic disorders Dermatitis herpetiformis[6] Autoimmune disorder as a result of gluten sensitivity leading to the formation of IgA antibodies + Any, mean age of disease onset is 2nd-4th decade Multiple
  • Excoriated papules, plaques and vesicles arranged in a clustered fashion
  • Symmetrical
  • Erosions and excoriations
  • Extensor surfaces including arms, knees, and buttocks.
+
  • Oral manifestation such as vesicles and erosion may be present
Nl Nl
Immune deficiency Wiskott-Aldrich syndrome[7] + Seen almost exclusively in males in infancy Multiple Rash can involve lesions located at the same areas of classical atopic dermatitis:

extensor surfaces of extremities and cheeks or scalp

+ Infants can present with petechiae, prolonged bleeding from umbilicus or circumcision, purpura,hematemesis, melena, epistaxis, hematuria or unusal bruising Nl to ↑

(Eosinophilia)

  • Epidermal psoriasiform hyperplasia
  • Marked intercellular edema with spongiotic vesiculation
Hyper-IgE syndrome[8] + Rare, begin in infancy Multiple
  • Face and scalp
  • Upper trunk and shoulders
  • Buttocks
  • Area behind the ears and around the hairline
+ +
  • Characteristic coarse facies
  • Increased alar width and broad nasal bridge
  • High-arched oral palate
  • Hyperextensible joints
Nl to ↑

(Eosinophilia)

  • Eosinophil-rich infiltration around the hair follicles
Malignancy Mycosis fungoides Clonal expansion of CD4+ memory T cells (CD45RO+) + Mean age is 55- 60 years Multiple
  • Asymmetrical
  • Hips, groin and trunk
+ Nl Nl

References

  1. Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF (2009). "Allergic and irritant contact dermatitis". Eur J Dermatol. 19 (4): 325–32. doi:10.1684/ejd.2009.0686. PMID 19447733.
  2. Bains SN, Nash P, Fonacier L (October 2018). "Irritant Contact Dermatitis". Clin Rev Allergy Immunol. doi:10.1007/s12016-018-8713-0. PMID 30293200.
  3. Voicu C, Tebeica T, Zanardelli M, Mangarov H, Lotti T, Wollina U, Lotti J, França K, Batashki A, Tchernev G (July 2017). "Lichen Simplex Chronicus as an Essential Part of the Dermatologic Masquerade". Open Access Maced J Med Sci. 5 (4): 556–557. doi:10.3889/oamjms.2017.133. PMC 5535688. PMID 28785363.
  4. Thyssen JP, Godoy-Gijon E, Elias PM (June 2013). "Ichthyosis vulgaris: the filaggrin mutation disease". Br. J. Dermatol. 168 (6): 1155–66. doi:10.1111/bjd.12219. PMID 23301728.
  5. Chavanas S, Bodemer C, Rochat A, Hamel-Teillac D, Ali M, Irvine AD, Bonafé JL, Wilkinson J, Taïeb A, Barrandon Y, Harper JI, de Prost Y, Hovnanian A (June 2000). "Mutations in SPINK5, encoding a serine protease inhibitor, cause Netherton syndrome". Nat. Genet. 25 (2): 141–2. doi:10.1038/75977. PMID 10835624.
  6. Kárpáti S (2012). "Dermatitis herpetiformis". Clin. Dermatol. 30 (1): 56–9. doi:10.1016/j.clindermatol.2011.03.010. PMID 22137227.
  7. Buchbinder D, Nugent DJ, Fillipovich AH (2014). "Wiskott-Aldrich syndrome: diagnosis, current management, and emerging treatments". Appl Clin Genet. 7: 55–66. doi:10.2147/TACG.S58444. PMC 4012343. PMID 24817816.
  8. Mogensen TH (April 2013). "STAT3 and the Hyper-IgE syndrome: Clinical presentation, genetic origin, pathogenesis, novel findings and remaining uncertainties". JAKSTAT. 2 (2): e23435. doi:10.4161/jkst.23435. PMC 3710320. PMID 24058807.