Pierre, 48 years old, Inflammatory flare-up
Written with the participation of FDVF (Future Dermatologists and Venereologists of France) interns.
Related topics
- Dryness / Atopy / Eczema
- Adult with a history of eczema since childhood
- Inflammatory dermatosis flare-ups
- Dry skin
- Pruritus with scratching lesions
- Family and friends: NTR
- No animals
- Family history of atopy
Quiz
29 respondents
Question of 1
What is your diagnosis? (only one correct response)
Mycosis
Wrong answer!
It was atopic dermatitis.
Let’s rule out differential diagnoses:
- Psoriasis
Also found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.
Histology if necessary.
- Atopic dermatitis:
Flare-ups with periods of remission, history of atopy, pruritus, xerosis.
Location of the lesions: face, skin folds, limbs.
Jagged eczema lesions.
No infectious contact or animals.
- Mycosis (ringworm):
Lesions with geographic edges, inflammatory at the edges, with scarring at the centre, centrifugal, recent +- pruritic. Animal contact and mycology if necessary.
Atopic dermatitis
Atopic dermatitis
It is indeed atopic dermatitis.
Let’s rule out differential diagnoses:
- Psoriasis
Also found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.
Histology if necessary.
- Atopic dermatitis:
Flare-ups with periods of remission, history of atopy, pruritus, xerosis.
Location of the lesions: face, skin folds, limbs.
Jagged eczema lesions.
No infectious contact or animals.
- Mycosis (ringworm):
Lesions with geographic edges, inflammatory at the edges, with scarring at the centre, centrifugal, recent +- pruritic. Animal contact and mycology if necessary.
PSORIASIS:
Psoriasis
Wrong answer!
It was atopic dermatitis.
Let’s rule out differential diagnoses:
- Psoriasis
Also found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.
Histology if necessary.
- Atopic dermatitis:
Flare-ups with periods of remission, history of atopy, pruritus, xerosis.
Location of the lesions: face, skin folds, limbs.
Jagged eczema lesions.
No infectious contact or animals.
- Mycosis (ringworm):
Lesions with geographic edges, inflammatory at the edges, with scarring at the centre, centrifugal, recent +- pruritic. Animal contact and mycology if necessary.
- Presence of pruritus: Yes
- Progression: In flare-ups with periods of remission
- Lesions: The patient has jagged eczema lesions and scratching lesions
- History: The patient has a family history of atopy
- Onset: In childhood
- Xerosis: +- generalised
- No additional examinations to be performed in theory
Dermatological treatment:
Topical corticosteroids can be prescribed as firstline therapy. What is dangerous is steroid phobia!
In short: potent class such as betamethasone.
- Initial treatment: Once a day paying attention to the maximum amount, should be started early and continued until clearing.
- In the event of failure: Phototherapy, immunosuppressant, biotherapy/ hospitalisation.
- Maintenance treatment:
- Either once or twice a week if flare-ups are frequent
- Or discontinue topical corticosteroids and resume
Dermo-cosmetic support:
Use of emollients: at least once a day – that is the basic principle behind maintenance treatment for AD! Moisturises, reduces micro-inflammation and pruritus, regulates the microbiome, eliminates the need for cortisone.
Advice for parents:
- Steroid phobia
- Hygiene
- Cleanse with warm water without soap
- Avoid wool and synthetic textiles: favour cotton
- Avoid tobacco
- Adopt scratching avoidance strategies
- Normal vaccination schedule
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