Thaïs, 9 years old, Cutaneous anomalies

Written with the participation of FDVF (Future Dermatologists and Venereologists of France) interns.

Clinical presentation

Child of Caribbean origin
Spinulosa-like dermatosis
Dry skin
Pruritus with scratching lesions
Family and friends: NTR
No animals
Family history of atopy

Quiz

15 respondents

Question of 1

What is your diagnosis? (only one correct response)

Scabies

Wrong answer!

It was atopic dermatitis.

Let’s rule out differential diagnoses:

Scabies:

Nocturnal pruritus, pruritus in family members, infectious contact, clinical features with furrows.

Psoriasis:

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.

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

True

Atopic dermatitis

It is indeed atopic dermatitis.

Let’s rule out differential diagnoses:

Scabies:

Nocturnal pruritus, pruritus in family members, infectious

contact, clinical features with furrows.

Psoriasis:

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.

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

Wrong answer!

It was atopic dermatitis.

Let’s rule out differential diagnoses:

Scabies:

Nocturnal pruritus, pruritus in family members, infectious contact, clinical features with furrows.

Psoriasis:

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.

Mycosis (ringworm):

Lesions with geographic edges, inflammatory at the edges, with scarring at the centre, centrifugal, recent +- pruritic.

Animal contact and mycology if necessary.

Mycosis

Wrong answer!

It was atopic dermatitis.

Let’s rule out differential diagnoses:

Scabies:

Nocturnal pruritus, pruritus in family members, infectious contact, clinical features with furrows.

Psoriasis:

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.

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
Onset: before the age of 2
Progression:in flare-ups with periods of remission
Lesions: The patient has jagged eczema lesions and scratching lesions
Xerosis: +- generalised
History: The patient has a family history of atopy
Other elements: The spinulosic form is typical on black skin

No additional examinations to be performed in general. The diagnosis is clinical
Allergy tests are only indicated if there is an associated disease: asthma, rhinitis, or suspected food allergy or contact eczema.

Dermatological treatment:

Topical corticosteroids can be prescribed as first line therapy. What is dangerous is steroid phobia!

In short: low-potency class such as desonide (Tridesonit®)

Initial treatment:

Once a day with no maximum amount, should be started early and continued until clearing.

Maintenance treatment:

- Either once or twice a week if flare-ups are frequent

- Or discontinue topical corticosteroids and resume from the first signs of relapse if flare-ups are less frequent.

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.