Percorsi clinici
Dermatite atopica. Da un singolo caso importanti insegnamenti
ATOPIC DERMATITIS: LEARNING BY A CLINICAL CASE
GIULIA PALONI, ROSANNA MENEGHETTI, ANNAMARTINA FRANZIL, FEDERICO MARCHETTI, GIORGIO LONGO
Clinica Pediatrica, Istituto per l’Infanzia, IRCCS “Burlo Garofolo”, Trieste
Gennaio 2008 - pagg. 33 -37
Abstract
Atopic dermatitis is a chronic inflammatory skin disorder with immunological etiology. It is
characterized by itchy, exudative lesions and a particular “dry skin”. It is a very common disease
and the evidence supporting the efficacy and safety of standard treatments are well established.
Nevertheless, it is very difficult to obtain an adequate compliance by parents, especially
because of unclear and uncomplete explanation about the right treatment. Frequently,
parents are concerned about the possibility of adverse effects of topical glucocorticoids and
they do not understand the importance of topical care. On the other hand, an inappropriate
avoidance diet can cause severe nutritional damages withouth any skin improvement. We
report a case of a 9-month-old boy affected by serious atopic dermatitis which was wrongly
treated. His mother was reticent to treat the boy with topical corticosteroid and she understood
that the main treatment was the avoidance diet, but she was exhausted and wanted relief for
her child. How should the problem be managed?
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
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Medico e Bambino (allegato) 2003, n° 3.
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3. Hywel CW. Atopic Dermatitis. N Engl J Med 2005;352:2314-24.
4. Sator P, Schmidt J, Hönigsmann H. Comparison of epidermal hydration and skin surface lipids in healthy individuals and in patients with atopic dermatitis. J Am Acad Dermatol 2003;48(3):352-8.
5. Vasilopoulos Y, Cork MJ, Murphy R, et al. Genetic association between an AACC insertion in the 3’UTR of the stratum corneum chymotryptic enzyme gene and atopic dermatitis. J Invest Dermatol 2004;123(1):62-6.
6. Rippke F, Schreiner V, Doering T, Maibach HI. Stratum corneum pH in atopic dermatitis: impact on skin barrier function and colonization with Staphylococcus aureus. Am J Clin Dermatol 2004;5(4):217-23.
7. Machura E, Mazur B, Golemiec E, Pindel M, Halkiewicz F. Staphylococcus aureus skin colonization in atopic dermatitis children is associated with decreased IFN-gamma production by peripheral blood CD4(+) and CD8(+) T cells. Pediatr Allergy and Immunol. Online Early Article, Published article online: 27-Jul-2007.
8. Gould HJ, Takhar P, Harries HE, Chevretton E, Sutton BJ. The allergic march from Staphylococcus aureus superantigens to immunoglobulin E. Chem Immunol Allergy 2007;93:106-36.
9. Miceli Sopo S. Quanto conta l’allergia alimentare nella genesi della dermatite atopica? Medico e Bambino 2004;10:631-9.
10. Hanifin JM, Cooper KD, Ho VC, et al. Guidelines of care for atopic dermatitis, developed in accordance with the American Academy of Dermatology (AAD)/American Academy of Dermatology Association “Administrative Regulations for Evidence-Based Clinical Practice Guidelines”. J Am Acad Dermatol 2004;50(3):391-404.
11. Ellis C, Luger T, Abeck D, Allen R, Graham-Brown RA, De Prost Y. International Consensus Conference on Atopic Dermatitis II (ICCAD II): clinical update and current treatment strategies. Br J Dermatol 2003;148 Suppl 63:3-10.
12. Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic dermatitis. Health technology Assessment 2000;4:1- 191.
13. Longo G, Berti I, Calvani M. La fabbrica dei superallergici chiude i battenti o apre nuove filiali? RIAP 2006;6:11-23.
14. Longo G, Barbi E, Meneghetti R, et al. Anafilassi da allergia alle proteine del latte vaccino: clinica, storia naturale, challenge e desensibilizzazione orale. Medico e Bambino 2004;23 (1):20-9.
15. Sampson HA. Utility of food-specific IgE concentration in predicting symptomatic food allergy. J Allergy Clin Immunol 2001;107:891- 896.
2. Eichenfield LF, Hanifin JM, Luger TA, Stevens SR, Pride HB. Consensus Conference on pediatric atopic dermatitis. J Am Acad Dermatol 2003;49(6):1088-95.
3. Hywel CW. Atopic Dermatitis. N Engl J Med 2005;352:2314-24.
4. Sator P, Schmidt J, Hönigsmann H. Comparison of epidermal hydration and skin surface lipids in healthy individuals and in patients with atopic dermatitis. J Am Acad Dermatol 2003;48(3):352-8.
5. Vasilopoulos Y, Cork MJ, Murphy R, et al. Genetic association between an AACC insertion in the 3’UTR of the stratum corneum chymotryptic enzyme gene and atopic dermatitis. J Invest Dermatol 2004;123(1):62-6.
6. Rippke F, Schreiner V, Doering T, Maibach HI. Stratum corneum pH in atopic dermatitis: impact on skin barrier function and colonization with Staphylococcus aureus. Am J Clin Dermatol 2004;5(4):217-23.
7. Machura E, Mazur B, Golemiec E, Pindel M, Halkiewicz F. Staphylococcus aureus skin colonization in atopic dermatitis children is associated with decreased IFN-gamma production by peripheral blood CD4(+) and CD8(+) T cells. Pediatr Allergy and Immunol. Online Early Article, Published article online: 27-Jul-2007.
8. Gould HJ, Takhar P, Harries HE, Chevretton E, Sutton BJ. The allergic march from Staphylococcus aureus superantigens to immunoglobulin E. Chem Immunol Allergy 2007;93:106-36.
9. Miceli Sopo S. Quanto conta l’allergia alimentare nella genesi della dermatite atopica? Medico e Bambino 2004;10:631-9.
10. Hanifin JM, Cooper KD, Ho VC, et al. Guidelines of care for atopic dermatitis, developed in accordance with the American Academy of Dermatology (AAD)/American Academy of Dermatology Association “Administrative Regulations for Evidence-Based Clinical Practice Guidelines”. J Am Acad Dermatol 2004;50(3):391-404.
11. Ellis C, Luger T, Abeck D, Allen R, Graham-Brown RA, De Prost Y. International Consensus Conference on Atopic Dermatitis II (ICCAD II): clinical update and current treatment strategies. Br J Dermatol 2003;148 Suppl 63:3-10.
12. Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic dermatitis. Health technology Assessment 2000;4:1- 191.
13. Longo G, Berti I, Calvani M. La fabbrica dei superallergici chiude i battenti o apre nuove filiali? RIAP 2006;6:11-23.
14. Longo G, Barbi E, Meneghetti R, et al. Anafilassi da allergia alle proteine del latte vaccino: clinica, storia naturale, challenge e desensibilizzazione orale. Medico e Bambino 2004;23 (1):20-9.
15. Sampson HA. Utility of food-specific IgE concentration in predicting symptomatic food allergy. J Allergy Clin Immunol 2001;107:891- 896.
Corrispondenza: ongog@burlo.trieste.it