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Address correspondence to Dr. Donald Rudikoff, Mount Sinai School of Medicine, Department of Dermatology, Box 1048, 1 Gustave L. Levy Place, New York, NY 10029, USA.
Figure 1Facial involvement is common in infants with atopic dermatitis but often disappears
after 6 months to 1 year of age.1 This toddler continues to exhibit involvement of the cheeks with erythema and excoriation.
Perioral lesions are evident as well. Impetigo often complicates the care of these
patients.
Figure 2Involvement of the forearms with erythematous, scaly, and crusted subacute lesions
in a 4-year-old child. Extensor involvement, common in infancy and early childhood,
then gives way to a pattern of flexural predominance in older children and adolescents.
Figure 3Cheilitis and perioral involvement is encountered frequently in children with atopic
dermatitis. Lip licking and mouth breathing results in a cycle of wetting and evaporation
that promotes chapping and further dermatitis.
Figure 4Although not included in the Hanifin and Rajka criteria2 for atopic dermatitis, infra-auricular fissuring is so common among patients with
atopic dermatitis that many practitioners consider it a reliable diagnostic feature.
Figure 5Atopic dermatitis in a toddler with eyelid and perioral erythema and scaling as well
as extensive involvement of the chest and shoulders. Central pallor and “mournful
facies” are characteristic. He has not as yet developed “atopic shiners” (darkness
around the eyes).
Figure 6Patients with atopic dermatitis typically exhibit nasal colonization with Staphylococcus aureus. Crusting and fissuring around the external nares is a frequent consequence.5 Interestingly, the subungual spaces of atopic dermatitis patients are also colonized
with staph.6
Figure 7Infantile atopic dermatitis typically presents with bright red, oozing, and crusted
patches on the cheeks and extensor aspects of the extremities. A variety of proprietary
or prescription medications may have been applied before dermatologic consultation.
Parents often express concern about the use of topical corticosteroids and some manifest
frank “steroid phobia.”7
Figure 8Infants with atopic dermatitis may have bright red erythema of the cheeks with oozing
and crusting or they may have dry, erythematous patches. Central pallor of the face
(“headlight sign”) is noted. Dennie-Morgan folds are also apparent and probably result
from eyelid dermatitis. They are not pathognomonic of atopic dermatitis, however,
and can be seen as a normal variant.
Figure 10Dermatitis of the hands with erythema, crusting, and fissuring causes significant
discomfort in children and adults alike. Although flexural lichenification of the
extremities is classic after the infantile stage, widespread papular involvement of
the extensors can persist, as in this child with widespread papulation of the hands,
arms and legs.
Figure 11Scalp involvement occurs in many children with atopic dermatitis but differs in appearance
from the cradle cap seen in infantile seborrheic dermatitis, where thick greasy scales
predominate.3 Dermatophyte infection should be ruled out in older children.
Figure 12Papulation, erosion, and crusting of the extensor aspect of the wrist in early childhood.
Hand dermatitis extending to the wrists and distal forearms is a good indicator for
atopic dermatitis.
Figure 13The process of lichenification results from chronic rubbing of a pruritic area. Lichenoid
papules coalesce into plaques that subsequently display exaggeration of the skin lines.
Hyperpigmentation of lesional skin in darker complected individuals results from postinflammatory
hyperpigmentation.
Figure 14Pityriasis alba often occurs on the face but can present in other areas. It is thought
to represent a low-grade eczema with postinflammatory hypopigmentation, although the
exact pathophysiology is not entirely known.8
Figure 16Characteristic flexural involvement seen in adolescents and adults with atopic dermatitis.
There is erythema, lichenification, and excoriation involving the antecubital fossae
and trunk.
Figure 20Patches, plaques, and papules of erythema over a widespread area of the back. Crusted
erosions and excoriations also are seen in this acute exacerbation of atopic dermatitis.
