It is an idiopathic inflammatory skin disease related to genetic allergic qualities, similar to eczema, often accompanied by asthma and allergic rhinitis.
Its manifestations differ at different ages and are divided into infancy, childhood, and young adulthood.
Infantile stage
About 60% of patients develop the disease within 1 year of age, and it is more common after 2 months of age.
The initial lesions are pruritic erythematous spots on the cheek and face, followed by pinhead-sized papules and papules that appear in dense patches, with polymorphic lesions and indistinct boundaries.
The disease is sometimes mild and sometimes severe, and can be aggravated by certain food or environmental factors, sometimes secondary to infection.
Generally, the disease gradually improves and heals within the age of 2 years, but some of the disease is delayed and develops into childhood.
Childhood
Most of them occur after 1-2 years of remission in infancy and gradually worsen, and a few of them continue to occur since infancy.
The lesions involve the flexors or extensors of the extremities, often limited to the elbow fossa and the caddis fossa (four bends), followed by the eyelids and face.
The skin of the whole body is dry, the lesions are dark red, the exudation is lighter than in infancy, often accompanied by scratch marks and other secondary lesions, and mossy lesions are formed over time.
Itching is still very intense at this stage, forming a vicious cycle of “itching – scratching – itching”.
Young adult stage
It can develop from childhood or occur directly.
It is more likely to occur in the elbow fossa, grasshopper fossa, extremities and trunk.
The lesions often appear as limited mossy lesions, sometimes with acute or subacute eczema-like changes, and in some patients with generalized dry papules.
Itching is intense, and secondary lesions such as blood crust, scaling and pigmentation appear after scratching.
Diagnosis
Medical history: personal, family history of inherited allergies.
Clinical features: specific pattern of occurrence and development of lesions in three phases.
Elevated serum IgE levels, eosinophilia, etc.
Treatment
Parents carefully observe and identify factors that may induce aggravation and try to avoid them.
Appropriate reduction of bathing and use of soap to avoid excessive removal of sebaceous film and aggravation of skin dryness; simultaneous topical moisturizers.
Topical medication: The principles are the same as those for eczema. Glucocorticoids are the main drugs to control the condition and relieve symptoms, and should be used appropriately according to age and lesion condition, long-term use adverse reactions! In recent years topical immunomodulators (such as tacrolimus) are effective, and when combined with infection add antibiotic creams such as Bactrim.
Internal drug treatment: antihistamines can relieve itching and reduce scratching; additional antibiotics are needed for secondary bacterial infections.