Atopic dermatitis in infancy L20.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

atopic dermatitis; Constitutional infant eczema; crusta lactea; eccema infantum; Eczema Infant Eczema constitutional; Eczematoid; Infant atopic eczema; Infant Eczema; Milk crust; Neurodermatitis

Definition
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Chronic form of infant eczema which, in contrast to seborrhoeic eczema in childhood, does not manifest itself before the 3rd month of life.

Etiopathogenesis
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Various factors are discussed, including nutritional disturbances/allergies (cow's milk, egg, acidic foods, tomatoes), dysfunction of the sebaceous glands, infections caused by Malassezia species. Real food allergies, however, are only found in about 1/3 of infants.

Manifestation
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In the 1st year of life, not before the 3rd month of life.

Localization
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Beginning on the cheeks, then capillitium, neck, extremities (more on the extensor side than the flexor side), possibly the entire body surface.

Clinical features
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Dermatitis with varying degrees of severity, chronic persistence or recurrence, which can range from mild sebostasis to diffuse erythema and extensive inflammatory foci of the skin.

In addition to diffuse scaly erythema, small papules, papulovesicles or scaly plaques are formed. This is always accompanied by varying degrees of itching, which is often excruciating and does not allow the infants (and their parents) to rest. A transition to weeping, later encrusted eczema plaques is possible.

Often secondary bacterial infections, especially in weeping areas.

On the capillitium areal adherent scale deposits possible, which may cover the entire area of the hairy head evenly. The comparison to burnt milk led to the term crusta lactea or milk crust.

The maximum variant is the infant's erythrodermal atopic eczema (S.a. Eczema atopic erythrodermal).

The diaper area typically remains free, even in the case of a pronounced and extensive eczema reaction (important diagnostic sign).

Therapy
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Avoid possible triggering allergens, e.g. milk protein, contact with animal epithelia. Wear air-permeable clothing (preferably cotton). Symptomatic external therapy with caring external agents such as Ungt. emulsif. aq., 2-5% urea cream/lotio (Eucerin 3% urea lotion, R102 ), Penaten oil, 5% dexpanthenol cream (e.g. Bepanthen cream, R064 ), bathing in oil baths (e.g. Balneum Hermal), avoiding irritation and occlusion.

Progression/forecast
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Healing, but also transition to atopic eczema in adults possible.

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020