[Dermatology] Atlas of Atopic Dermatitis, Eczema, and Noninfectious Immunodeficiency Disorders

These are pictures of Atopic Dermatitis, Eczema, and Noninfectious Immunodeficiency Disorders. This is a part of the Andrews' Diseases of the Skin Clinical Atlas 1st Edition 2018 book

Dermatitis can present with a variety of physical examination findings ranging from exuberant oozing to dry scale. These findings represent the acute and chronic inflammation that defines a variety of dermatitides and eczematous conditions. Intense itching that accompanies these conditions can lead to overlying excoriations and eventually thickening of the skin known as lichenification. Ultimately, constant itching and a poor epidermal barrier predispose patients with these eczematous conditions to repeated skin infections from bac- teria and viruses, which can present with pustules, vesicles, crusting, erosions, or painful nodules. Screening for signs of such infections is an important part of the physical examina- tion for all patients with dermatitis, especially those with any underlying immunodeficiency.

Although most cases will not require a skin biopsy for a diagnosis, the spongiosis of acute dermatitis or the acanthosis of the epidermis seen in chronic dermatitis can be confirma- tory in scenarios wherein other diagnoses that affect the epidermis are being considered, such as nutritional deficien- cies, graft-versus-host disease, or psoriasis.

The anatomic location of atopic dermatitis (AD) can vary depending on age. Infantile AD tends to affect the cheeks and can have impressive overlying exudation and crusting even in the absence of infection. In infants, AD can also be quite wide- spread with predilections for extensor surfaces and notable sparing of the diaper region and nose, the so-called headlight sign. Childhood AD may be more localized to the flexors and can begin to take on a more lichenified appearance. Many people with AD will outgrow a more widespread dermatitis, but may have chronic hand dermatitis or other more local- ized flares of their AD. Associated features of AD found on physical examination include Dennie-Morgan lines (accen- tuated folds of the lower eyelids), keratosis pilaris, general xerosis, follicular accentuation, and signs of atopy such as hyperpigmentation around the eyes known as allergic shiners. Other forms of eczema may take on different patterns on the body, including the coin-shaped, scaly, and exudative plaques of nummular eczema or the diffuse, dry, and cracked appearance of xerotic eczema (eczema craquele). Even in patients without a history of AD, localized forms of eczema may arise on the eyelids or nipples, or on the hands as vesicu- lobullous hand eczema (pompholyx). Finally, some forms of immunodeficiency disorders can present with relatively nonspecific exfoliative erythroderma, as in severe combined immunodeficiency (SCID), or an atopic dermatitis-like erup- tion, as in hyper–immunoglobulinemia E (IgE) syndrome, Wiskott-Aldrich syndrome (WAS), or DiGeorge syndrome. In these cases, the astute clinician will observe distinctive clini- cal findings such as the pustular eruption of hyper-IgE syn- drome, dysmorphisms of DiGeorge syndrome, or petechiae within the dermatitis of patients with WAS. This portion of the atlas will highlight the range of clinical findings seen in patients with atopic dermatitis and other forms of eczema, along with rarer findings seen in patients with immunodeficiency syndromes.

Fig. 5.1 Atopic dermatitis.

Fig. 5.2 Atopic dermatitis

Fig. 5.3 Atopic dermatitis

Fig. 5.4 Chronic atopic dermatitis

Fig. 5.5 Atopic dermatitis with excoriations

Fig. 5.6 Atopic dermatitis with secondary infection

Fig. 5.7 Atopic dermatitis

Fig. 5.8 Atopic dermatitis

Fig. 5.9 Atopic dermatitis with secondary infection

Fig. 5.10 Atopic dermatitis

Fig. 5.11 Chronic atopic dermatitis

Fig. 5.12 Chronic atopic dermatitis

Fig. 5.13 Chronic atopic dermatitis with hyperpigmentation

Fig. 5.14 Atopic dermatitis, lichenification

Fig. 5.15 Atopic dermatitis.

Fig. 5.16 Papular atopic dermatitis

Fig. 5.17 Atopic dermatitis.

Fig. 5.18 Atopic dermatitis with Dennie-Morgan lines

Fig. 5.19 White dermatographism.

Fig. 5.20 Erythroderma from atopic dermatitis.

Fig. 5.21 Pityriasis alba

Fig. 5.22 Hyperlinear palms in a patient with active atopic dermatitis

Fig. 5.23 Keratosis pilaris

Fig. 5.24 Keratosis pilaris

Fig. 5.25 Keratosis pilaris rubra faciei.

Fig. 5.26 Eczema herpeticum

Fig. 5.27 Ear eczema

Fig. 5.28 Eyelid eczema

Fig. 5.29 Nipple eczema in an atopic child

Fig. 5.30 Hand dermatitis with secondary infection

Fig. 5.31 Finger dermatitis from primrose allergy

Fig. 5.32 Pompholyx

Fig. 5.33 Pompholyx

Fig. 5.34 Irritant diaper dermatitis. Note sparing of folds

Fig. 5.35 Id reaction

Fig. 5.36 Xerotic eczema

Fig. 5.37 Nummular eczema

Fig. 5.38 Nummular eczema

Fig. 5.39 Job’s syndrome

Fig. 5.40 Job’s syndrome

Fig. 5.41 Job’s syndrome with secondary infection

Fig. 5.42 Eczema in Wiskott-Aldrich syndrome

Fig. 5.43 Ataxia telangiectasia

Fig. 5.44 Granulomatous lesions in ataxia telangiectasia

Fig. 5.45 Common variable immunodeficiency with granulomas in vitiligo.

Fig. 5.46 Common variable immunodeficiency 

with granulomas in vitiligo

Fig. 5.47 Common variable immunodeficiency with chronic candidiasis

Fig. 5.48 Warts in DOCK8 immunodeficiency

Fig. 5.49 Warts in DOCK8 immunodeficiency

Fig. 5.50 Warts in DOCK8 immunodeficiency

Fig. 5.51 Subacute lupus erythematosus as can be seen in 

complement deficiency disorders

Fig. 5.52 Acute graft-versus-host disease

Fig. 5.53 Acute graft-versus-host disease grade 2

Fig. 5.54 Acute graft-versus-host disease grade 2

Fig. 5.55 Acute graft-versus-host disease grade 4

Fig. 5.56 Acute graft-versus-host disease

Fig. 5.57 Lichenoid graft-versus-host disease

Fig. 5.58 Chronic graft-versus-host disease

Fig. 5.59 Chronic graft-versus-host disease, oral

Fig. 5.60 Chronic graft-versus-host disease, sclerodermoid type

Fig. 5.61 Chronic graft-versus-host disease

Fig. 5.62 Sclerodermoid graft-versus-host disease

Fig. 5.63 Sclerodermoid graft-versus-host disease

Fig. 5.64 Fasciitis in graft-versus-host disease

REFERENCES

Andrews' Diseases of the Skin Clinical Atlas 1st Edition 2018