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Atopic Dermatitis in 3-month-old infant

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Abstract

Dermatological manifestations of atopic dermatitis (AD) in infants may simulate those of infantile seborrheic dermatitis and eczematous scabies lesions. Hence, prior to a confirmatory diagnosis of atopic dermatitis in pediatric patients, all suspected dermal skin diseases must be ruled out. Untreated AD in infants may result in major complications, for instance, eczema herpeticum. Primary signs of AD in infants include pruritus, facial and extensor involvement of lesions, and a chronic or chronically relapsing dermatitis. Avoiding environmental triggers and regular use of skin moisturizing agents, for hydration and occlusion of the skin surface, have been recommended in the management of these lesions. 

This is a case study of a 3-month-old infant who presented with reddish skin lesions around his nose and lips, along with itchy tenderness over his arms and legs. The baby had a history of atopic dermatitis in the past. He was diagnosed with a severe form of impetigo. The patients showed a positive response to treatment with hydrocortisone ointment and oral antibiotics. Once the symptoms subsided, a topical moisturizer containing squalene, vitamin E, and aloe vera extracts was prescribed as an adjunctive therapy for three months, which assisted in reducing roughness in the rashes, moisturizing the skin, and preventing itchiness and spread of the residual lesions. After the completion of the treatment period, the baby’s skin rashes disappeared and his scars lightened remarkably. 

Introduction 

Atopic dermatitis (AD) or atopic eczema is most common in infants; it has been reported in 20% of those under the age of two years. Untreated AD can lead to complications in infants, for instance, eczema herpeticum - a dermatological emergency having serious sequelae like eye or meningeal involvement.

Here, we describe a case of an infant who presented with reddish skin lesions around the nose, lips, and itchy tenderness over his arms and legs. The baby had been diagnosed with atopic dermatitis in the past. A topical moisturizer containing squalene, vitamin E, and aloe vera extract was prescribed as an adjunctive therapy for three months. This therapeutic regime helped in reducing roughness in the rashes, moisturized the skin, and prevented scratching and spread of the residual lesions.

Case Report

A 3-month-old infant who had a history of atopic dermatitis presented with reddish spots on his skin, especially around the nose and lips. 

On examination, apart from his face, the child also had itchy and tender scars on his arms and legs. Additionally, he had blisters in the diaper area which appeared to exude and form yellowish crusts. 

Once the infection had subsided, a topical moisturizer containing squalene, vitamin E, and aloe vera extract was prescribed as an adjunctive therapy. This measure reduced roughness in the rashes, left the skin moisturized, and prevented scratching and spread of the residual lesions. 

The topical regime was continued for about three months. On follow-up, rashes over the infant’s skin had disappeared and the scars had lightened significantly. 

Discussion

A number of factors contribute to the development of AD. The skin barrier and immunological hypotheses are the two main theories proposed for the pathogenesis of AD. 

Preventive measures are essential in the management of atopic dermatitis, reducing its exacerbation, and improving prognosis. These include the avoidance of environmental stimulators like pollen, grass, dust, soap, and chlorine, as well as sudden changes in temperature. Also, regular use of moisturizers has been recommended for patients with a history of AD. These moisturizers or emollients hydrate the skin and prevent sensitization with antigens by forming an occlusive layer. 

Dermatologically active natural agents, for example, those containing aloe vera are deemed safe and effective for ameliorating a variety of inflammatory skin conditions.

Vitamin E containing topical emollients are known to be suitable in treating pediatric dermatitis with symptoms like eczema, itching, desquamation and xerosis as well as inflammatory dermatoses.Furthermore, these topical agents have also demonstrated efficacy in resolving mild-to-moderate AD.

Researchers have also shown that topical formulations containing squalene demonstrate higher efficacy in skin rehydration for infants and children with AD when compared to a number of other topical agents.

Conclusion

This case study describes a 3-month-old infant with a history of atopic dermatitis and reddish skin lesions around his nose and lips, along with itchy tenderness over arms and legs. The diagnosis was confirmed as a severe form of impetigo. The baby’s symptoms subsided after treatment with hydrocortisone ointment and oral antibiotics. A topical moisturizer containing squalene, vitamin E, and aloe vera extract was prescribed as an adjunct, for three months, for hydration of the skin. This therapy helped in reducing roughness in the rashes and prevented itchiness and spread of the residual lesions. On follow-up, after three months, the baby’s skin rashes disappeared and the residual scars displayed aesthetic improvement.

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