Sunday, March 13, 2005

Atopic Infant

The patient is a one year old boy with an almost life-long history of atopic dermatitis. His father (age 30) has persistent facial eczema. His mother has significant food allergies (nuts and fruit cause angioedema and laryngeal edema). This child's facial eczema has proved difficult to control. Topical steroids have been of value (fluocinalone 0.25% ointment); but topical tacrolimus and pimecrolimus have not been effective. I suspect he may have food allergies. In addition, there is a cat at home. I think he needs to be tested for cat allergy. Food testing is controversial. Would serum IgE measurement be of value? Role of staph superinfection needs to be considered as staph, acting as a superantigen, may be driving this. I'd appreciate your thoughts. DJE


Child S.A.D. Posted by Hello


Child S.A.D. Posted by Hello

3 comments:

  1. This looks like classical atopic dermatitis but the crusted areas around the nose and periorally may suggest secondary staph infection. I would add a oral anti staph/strep antibiotics in addition to topical hydrocortisone cream bd .

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  2. Yes indeed a difficult situation to handle.
    Oral and topical antibiotics with topical steroid (fluticasone/mometasone) combined with liberal use of emollients will bring down the crisis and then maintain with moisturisers/emollients.
    Small tapering doses of oral prednisolone may be required initially.
    We understand that topicaal tacrolimus and pimecrolimus is not approved for use in children below 2 years.
    All this theoretical approach is not as easy when translated into practice.
    The fine balance is amongst topical steroids, topical antibiotics and topical emollients.

    ReplyDelete
  3. Thanks Henry and Jayakar,
    This child is using topical mupirocin and fluocinalone now - I have stayed away from systemic steroids for the time being. I wonder about the cat at home and the role of cat dander. Sometimes, the diagnosis is clear, but the treatment is complicated and not effective. The infant has very caring and attentive parents - which is a start. DJE

    ReplyDelete

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