Atopic dermatitis differential diagnosis: Difference between revisions

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{{Atopic dermatitis}}
{{Atopic dermatitis}}


__NOTOC__
{{CMG}}; {{AE}} [[Ogechukwu Hannah Nnabude, MD]]; {{S.S}}
 
{{CMG}}; {{AE}} {{S.S}}
==Overview==
==Overview==
Atopic dermatitis is a chronic [[inflammatory]] skin disorder, which is indistinguishable from other causes of dermatitis. Atopic dermatitis is usually associated with personal or [[family history]] of [[atopic diseases]] including [[asthma]], allergic rhinitis and [[food allergy]]. The most common clinically similar dermatitis in infancy is [[seborrheic dermatitis]] which includes [[hyperkeratosis]] of the [[Scalp rash|scalp]], also found in atopic dermatitis.  
Atopic dermatitis is a chronic [[inflammatory]] [[skin disorder]], which is indistinguishable from other [[causes]] of dermatitis. Atopic dermatitis is usually associated with personal or [[family history]] of [[atopic diseases]] including [[asthma]], [[allergic rhinitis]] and [[food allergy]]. The most common clinically similar dermatitis in infancy is [[seborrheic dermatitis]] which includes [[hyperkeratosis]] of the [[Scalp rash|scalp]], also found in atopic dermatitis.  


==Atopic Dermatitis from other Diseases==
==Atopic Dermatitis from other Diseases==
Atopic dermatitis should be differentiated from [[allergic contact dermatitis]], [[iirritant contact dermatitis]], [[seborrheic dermatitis]], [[psoriasis]], [[lichen simplex chronicus]], [[ichthyosis vulgaris]], [[nummular dermatitis (discoid eczema)]], [[netherton's syndrome]], and [[dermatitis herpetiformis]]
{|
{|
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
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! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Eosinophils
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Eosinophils
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum IgE  
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum IgE
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Single/
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Single/
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atopic dermatitis]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atopic dermatitis]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Epidermal barrier dysfunction
*Epidermal barrier dysfunction
* [[Immune]] dysregulation
*[[Immune]] dysregulation
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Incidence]] is highest during [[infancy]] and early childhood.
*[[Incidence]] is highest during [[infancy]] and early childhood.
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
*[[Erythema]], [[Exudate|exudates]], [[papules]],[[vesicles]], scales and crusts
*[[Erythema]], [[Exudate|exudates]], [[papules]],[[vesicles]], scales and crusts
* Infiltrated [[erythema]], [[prurigo]], scales and crusts
*Infiltrated [[erythema]], [[prurigo]], scales and crusts
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Young children -[[Scalp]], [[cheeks]] amd [[extensor]] surface
*Young children -[[Scalp]], [[cheeks]] amd [[extensor]] surface
* [[Adolescent|Adolescents]] -flexural areas and buttock-thigh creases
*[[Adolescent|Adolescents]] -flexural areas and buttock-thigh creases
* Adults - facial involvement and skin flexures  
*Adults - facial involvement and skin flexures
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Centrofacial pallor
*Centrofacial pallor
* Delayed blanch response
*Delayed blanch response
* [[Keratosis pilaris]]
*[[Keratosis pilaris]]
* Palmar hyperlinearity
*Palmar hyperlinearity
* [[Pityriasis alba]]
*[[Pityriasis alba]]
* [[Ichthyosis]]
*[[Ichthyosis]]


* Infra-auricular and retro-auricular fissuring
*Infra-auricular and retro-auricular fissuring
* Nipple [[eczema]]
*Nipple [[eczema]]
* White dermographism
*White dermographism
* Perifollicular accentuation
*Perifollicular accentuation
| align="center" style="background:#F5F5F5;" | Nl to ↑
| align="center" style="background:#F5F5F5;" |Nl to ↑


([[Eosinophilia|Eosinophilia)]]
([[Eosinophilia|Eosinophilia)]]
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Epidermal psoriasiform [[hyperplasia]]
*Epidermal psoriasiform [[hyperplasia]]
* Marked intercellular [[edema]] with spongiotic vesiculation
*Marked intercellular [[edema]] with spongiotic vesiculation


* [[Hyperkeratosis]]
*[[Hyperkeratosis]]
* Psoriasiform [[hyperplasia]]
*Psoriasiform [[hyperplasia]]
* Dyskeratosis
*Dyskeratosis
| colspan="2" align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
*  
*
* [[Family history]] of [[atopic dermatitis]] or other [[atopy]]
*[[Family history]] of [[atopic dermatitis]] or other [[atopy]]
* Personal history of [[atopy]] ([[asthma]], [[allergic rhinitis]], [[food allergy]])
*Personal history of [[atopy]] ([[asthma]], [[allergic rhinitis]], [[food allergy]])
* Active and passive exposure to [[tobacco]]
*Active and passive exposure to [[tobacco]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Allergic contact dermatitis]]<ref name="pmid19447733">{{cite journal |vauthors=Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF |title=Allergic and irritant contact dermatitis |journal=Eur J Dermatol |volume=19 |issue=4 |pages=325–32 |date=2009 |pmid=19447733 |doi=10.1684/ejd.2009.0686 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Allergic contact dermatitis]]<ref name="pmid19447733">{{cite journal |vauthors=Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF |title=Allergic and irritant contact dermatitis |journal=Eur J Dermatol |volume=19 |issue=4 |pages=325–32 |date=2009 |pmid=19447733 |doi=10.1684/ejd.2009.0686 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Delayed-type [[hypersensitivity]] response
*Delayed-type [[hypersensitivity]] response
* Skin [[inflammation]] mediated by [[Haptens|hapten]]-specific T cells
*Skin [[inflammation]] mediated by [[Haptens|hapten]]-specific T cells
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Any
| align="center" style="background:#F5F5F5;" |Any
| align="center" style="background:#F5F5F5;" |May be multiple after 1-2 days of exposure
| align="center" style="background:#F5F5F5;" |May be multiple after 1-2 days of exposure
| align="center" style="background:#F5F5F5;" | Erythematous well-demarcated [[papules]]
| align="center" style="background:#F5F5F5;" |Erythematous well-demarcated [[papules]]
| align="center" style="background:#F5F5F5;" | Surrounding the area in contact with the offending agent  
| align="center" style="background:#F5F5F5;" |Surrounding the area in contact with the offending agent
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
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| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Stinging and burning
*Stinging and burning
* Localized [[swelling]]
*Localized [[swelling]]
* [[Lichenification|Lichenified]] [[Itch|pruritic]] [[plaques]]
*[[Lichenification|Lichenified]] [[Itch|pruritic]] [[plaques]]
| align="center" style="background:#F5F5F5;" |Nl to ↑  
| align="center" style="background:#F5F5F5;" |Nl to ↑  
([[Eosinophilia]])
([[Eosinophilia]])
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Eosinophilic]] spongiosis and [[microvesicles]]
*[[Eosinophilic]] spongiosis and [[microvesicles]]
* [[Exocytosis]] of [[eosinophils]] and [[lymphocytes]]  
*[[Exocytosis]] of [[eosinophils]] and [[lymphocytes]]
* Chronic - [[Hyperkeratosis]] and parakeratosis
*Chronic - [[Hyperkeratosis]] and parakeratosis
| colspan="2" align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Contact with [[allergens]] in the past 1-2 days
*Contact with [[allergens]] in the past 1-2 days
* Positive [[family history]]
*Positive [[family history]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Irritant contact dermatitis]]<ref name="pmid30293200">{{cite journal |vauthors=Bains SN, Nash P, Fonacier L |title=Irritant Contact Dermatitis |journal=Clin Rev Allergy Immunol |volume= |issue= |pages= |date=October 2018 |pmid=30293200 |doi=10.1007/s12016-018-8713-0 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Irritant contact dermatitis]]<ref name="pmid30293200">{{cite journal |vauthors=Bains SN, Nash P, Fonacier L |title=Irritant Contact Dermatitis |journal=Clin Rev Allergy Immunol |volume= |issue= |pages= |date=October 2018 |pmid=30293200 |doi=10.1007/s12016-018-8713-0 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Activation of the [[innate immune system]] by the pro-[[inflammatory]] properties of chemicals
*Activation of the [[innate immune system]] by the pro-[[inflammatory]] properties of chemicals
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Any, more with occupational exposure  
| align="center" style="background:#F5F5F5;" |Any, more with occupational exposure
| align="center" style="background:#F5F5F5;" |Usually single immediately after the exposure
| align="center" style="background:#F5F5F5;" |Usually single immediately after the exposure
| align="center" style="background:#F5F5F5;" | Well-demarcated red patch with a glazed surface
| align="center" style="background:#F5F5F5;" |Well-demarcated red patch with a glazed surface
| align="center" style="background:#F5F5F5;" | Any area in contact with the irritant
| align="center" style="background:#F5F5F5;" |Any area in contact with the irritant
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
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| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Swelling]], [[Blister|blistering]] and scaling of the damaged area
*[[Swelling]], [[Blister|blistering]] and scaling of the damaged area
* Dryness
*Dryness
* Thicker skin
*Thicker skin
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Spongiosis
*Spongiosis
* Intraepidermal [[vesicles]] or bullae
*Intraepidermal [[vesicles]] or bullae
* [[Necrosis]] of [[keratinocytes]]
*[[Necrosis]] of [[keratinocytes]]
| colspan="2" align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Cumulative exposure to [[irritants]]
*Cumulative exposure to [[irritants]]
* Negative hypersensitivity tests
*Negative hypersensitivity tests
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seborrheic dermatitis]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seborrheic dermatitis]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Not known
*Not known
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any, onset during the infancy and peak during 3rd-4th decades
| align="center" style="background:#F5F5F5;" |Any, onset during the infancy and peak during 3rd-4th decades
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Cradle cap]] - yellowish scales on the [[Scalp rash|scalp]]
*[[Cradle cap]] - yellowish scales on the [[Scalp rash|scalp]]
* Patchy or diffuse greasy scaling with or without a yellow-red base
*Patchy or diffuse greasy scaling with or without a yellow-red base
* Crusts
*Crusts
| align="center" style="background:#F5F5F5;" | Scalp, face, trunk, postauricular, diaper area and axilla
| align="center" style="background:#F5F5F5;" |Scalp, face, trunk, postauricular, diaper area and axilla
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Infants:
*Infants:
** [[Cradle cap]] (Sclap) - non-inflammatory greasy scales on the scalp
**[[Cradle cap]] (Sclap) - non-inflammatory greasy scales on the scalp
** Asymptomatic
**Asymptomatic
** Self resolving
**Self resolving
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Focal parakeratosis and spongiosis in epidermis
*Focal parakeratosis and spongiosis in epidermis
* Psoriasiform [[hyperplasia]]
*Psoriasiform [[hyperplasia]]
* [[Neutrophils]] at the margins
*[[Neutrophils]] at the margins
| colspan="2" align="center" style="background:#F5F5F5;" |Risk factors include
| colspan="2" align="center" style="background:#F5F5F5;" |Risk factors include
* [[Stress]]


* Cold, dry weather can cause flare ups
*[[Stress]]
* [[Superinfection]] with bacteria and [[candida]]
 
*Cold, dry weather can cause flare ups
*[[Superinfection]] with bacteria and [[candida]]
 
Generalized seborrheic [[erythroderma]] in immunodeficient patients
Generalized seborrheic [[erythroderma]] in immunodeficient patients
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Psoriasis]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Psoriasis]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Keratinocyte]] hyperproliferation
*[[Keratinocyte]] hyperproliferation
* Dysregulation of the [[immune system]]
*Dysregulation of the [[immune system]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any, 2 peaks of onset 30-39 years and 50-59 years
| align="center" style="background:#F5F5F5;" |Any, 2 peaks of onset 30-39 years and 50-59 years
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" | Well-circumscribed, pink [[papules]] and symmetrically distributed cutaneous [[plaques]] with silvery scales
| align="center" style="background:#F5F5F5;" |Well-circumscribed, pink [[papules]] and symmetrically distributed cutaneous [[plaques]] with silvery scales
| align="center" style="background:#F5F5F5;" |  
| align="center" style="background:#F5F5F5;" |
* Scalp
*Scalp
* Trunk
*Trunk
* Gluteal cleft
*Gluteal cleft
* Extensor surface of elbows and knees
*Extensor surface of elbows and knees
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | _
| align="center" style="background:#F5F5F5;" |_
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Auspitz's sign]]  (pinpoint bleeding)
*[[Auspitz's sign]]  (pinpoint bleeding)
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Epidermal]] [[hyperplasia]]
*[[Epidermal]] [[hyperplasia]]
* Parakeratosis
*Parakeratosis
* [[Neutrophils]] microabscesses (Munro microabscesses)
*[[Neutrophils]] microabscesses (Munro microabscesses)
| colspan="2" align="center" style="background:#F5F5F5;" |Risk factors include
| colspan="2" align="center" style="background:#F5F5F5;" |Risk factors include
* [[Smoking]]
 
* Skin trauma
*[[Smoking]]
* [[Alcohol abuse]]
*Skin trauma
* [[Stress]]
*[[Alcohol abuse]]
* Cold weather
*[[Stress]]
* Vitamin D deficiency  
*Cold weather
*Vitamin D deficiency
|-
|-
! align="center" style="background:#DCDCDC;" |[[Lichen simplex chronicus|Lichen simplex]] <ref name="pmid28785363">{{cite journal |vauthors=Voicu C, Tebeica T, Zanardelli M, Mangarov H, Lotti T, Wollina U, Lotti J, França K, Batashki A, Tchernev G |title=Lichen Simplex Chronicus as an Essential Part of the Dermatologic Masquerade |journal=Open Access Maced J Med Sci |volume=5 |issue=4 |pages=556–557 |date=July 2017 |pmid=28785363 |pmc=5535688 |doi=10.3889/oamjms.2017.133 |url=}}</ref>[[Lichen simplex chronicus|chronicus]]
! align="center" style="background:#DCDCDC;" |[[Lichen simplex chronicus|Lichen simplex]] <ref name="pmid28785363">{{cite journal |vauthors=Voicu C, Tebeica T, Zanardelli M, Mangarov H, Lotti T, Wollina U, Lotti J, França K, Batashki A, Tchernev G |title=Lichen Simplex Chronicus as an Essential Part of the Dermatologic Masquerade |journal=Open Access Maced J Med Sci |volume=5 |issue=4 |pages=556–557 |date=July 2017 |pmid=28785363 |pmc=5535688 |doi=10.3889/oamjms.2017.133 |url=}}</ref>[[Lichen simplex chronicus|chronicus]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Secondary to extensive [[pruritus]] due to other conditions such as [[Atopic dermatitis|atopic dermatitis,]] neuropathic pruritus, etc
*Secondary to extensive [[pruritus]] due to other conditions such as [[Atopic dermatitis|atopic dermatitis,]] neuropathic pruritus, etc
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any, peak at 30-50 years of age
| align="center" style="background:#F5F5F5;" |Any, peak at 30-50 years of age
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" | [[Lichenification|Lichenified]] and [[erythematous]], [[Itch|pruritic]] [[exudative]] [[Plaques|plaque]], and excoriations
| align="center" style="background:#F5F5F5;" |[[Lichenification|Lichenified]] and [[erythematous]], [[Itch|pruritic]] [[exudative]] [[Plaques|plaque]], and excoriations
| align="center" style="background:#F5F5F5;" | Scalp, head, neck, hands, arms, and genitals areas
| align="center" style="background:#F5F5F5;" |Scalp, head, neck, hands, arms, and genitals areas
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Color of [[Plaques|plaque]] varies from yellow to reddish brown  
*Color of [[Plaques|plaque]] varies from yellow to reddish-brown
* [[Plaque]] size can vary between 3X6 cm 6X10 cm areas.
*[[Plaque]] size can vary between 3X6 cm 6X10 cm areas.
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Markedly [[Hyperplasia|hyperplastic]] [[epidermis]]  
*Markedly [[Hyperplasia|hyperplastic]] [[epidermis]]
* Irregular [[hyperkeratosis]] and parakeratosis  
*Irregular [[hyperkeratosis]] and parakeratosis
* Thick granular zone
*Thick granular zone
* [[Acanthosis]]  
*[[Acanthosis]]
| colspan="2" align="center" style="background:#F5F5F5;" |Risk factors include
| colspan="2" align="center" style="background:#F5F5F5;" |Risk factors include
* [[Emotional stress]]
 
* Dry weather
*[[Emotional stress]]
* [[Sweating]]
*Dry weather
* [[Sexual dysfunction]]  
*[[Sweating]]
* [[Sleep disturbances]]
*[[Sexual dysfunction]]
* [[Depression]]
*[[Sleep disturbances]]
*[[Depression]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Ichthyosis vulgaris]]<ref name="pmid23301728">{{cite journal |vauthors=Thyssen JP, Godoy-Gijon E, Elias PM |title=Ichthyosis vulgaris: the filaggrin mutation disease |journal=Br. J. Dermatol. |volume=168 |issue=6 |pages=1155–66 |date=June 2013 |pmid=23301728 |doi=10.1111/bjd.12219 |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Ichthyosis vulgaris]]<ref name="pmid23301728">{{cite journal |vauthors=Thyssen JP, Godoy-Gijon E, Elias PM |title=Ichthyosis vulgaris: the filaggrin mutation disease |journal=Br. J. Dermatol. |volume=168 |issue=6 |pages=1155–66 |date=June 2013 |pmid=23301728 |doi=10.1111/bjd.12219 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Loss of function [[mutations]] in the [[Filaggrin|filaggrin gene (''FLG'')]]
*Loss of function [[mutations]] in the [[Filaggrin|filaggrin gene (''FLG'')]]
* [[Autosomal dominant inheritance]] with [[incomplete penetrance]]
*[[Autosomal dominant inheritance]] with [[incomplete penetrance]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Usually in infancy
| align="center" style="background:#F5F5F5;" |Usually in infancy
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Xerosis]] and gray [[Ichthyosis|scaling]]
*[[Xerosis]] and gray [[Ichthyosis|scaling]]
* [[Palmar]] hyperlinearity  
*[[Palmar]] hyperlinearity
* [[Keratosis pilaris]]
*[[Keratosis pilaris]]
| align="center" style="background:#F5F5F5;" |
* Extensor surfaces of the extremities
* Scalp
* Trunk
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Scales can vary from mild scaling to large, plate (armor)-like scales and thickening of the skin.
*Extensor surfaces of the extremities
| align="center" style="background:#F5F5F5;" | Nl
*Scalp
| align="center" style="background:#F5F5F5;" | Nl
*Trunk
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Reduced keratohyalin [[granules]]  
*Scales can vary from mild scaling to large, plate (armor)-like scales and thickening of the skin.
* [[Perinuclear space|Perinuclear]] [[keratin]] retractions in [[Granule cell|granular]] cells
| align="center" style="background:#F5F5F5;" |Nl
* Thick [[stratum corneum]]  
| align="center" style="background:#F5F5F5;" |Nl
* Basket-weave pattern of [[stratum corneum]]
| align="center" style="background:#F5F5F5;" |
*Reduced keratohyalin [[granules]]
*[[Perinuclear space|Perinuclear]] [[keratin]] retractions in [[Granule cell|granular]] cells
*Thick [[stratum corneum]]
*Basket-weave pattern of [[stratum corneum]]
| colspan="2" align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Increased risk of [[atopic diseases]] including [[asthma]], alllergic rhinitis and [[atopic dermatitis]]
*Increased risk of [[atopic diseases]] including [[asthma]], alllergic rhinitis and [[atopic dermatitis]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Nummular dermatitis|Nummular dermatitis (discoid eczema)]]
! align="center" style="background:#DCDCDC;" |[[Nummular dermatitis|Nummular dermatitis (discoid eczema)]]
| align="center" style="background:#F5F5F5;" | Unknown
| align="center" style="background:#F5F5F5;" |Unknown
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any,  two peaks, 6th-7th  decade of life in males and 2nd-3rd decade of life in females
| align="center" style="background:#F5F5F5;" |Any,  two peaks, 6th-7th  decade of life in males and 2nd-3rd decade of life in females
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Symmetrical  coin-shaped [[Erythematous rash|erythematous]] [[plaques]]
*Symmetrical  coin-shaped [[Erythematous rash|erythematous]] [[plaques]]
* Erosions and excoriations
*Erosions and excoriations
* Chronic lesions- central clearing leading to annular lesions
*Chronic lesions- central clearing leading to annular lesions
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Upper and lower extremities
*Upper and lower extremities
* Lower trunk
*Lower trunk
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Chronically [[lesions]] result into central clearing leading to annular lesions.
*Chronically [[lesions]] result into central clearing leading to annular lesions.
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Spongiosis
*Spongiosis
* [[Perivascular cell|Perivascular]] [[lymphocytic]] infiltrates, with [[eosinophils]] and occasional [[neutrophils]]
*[[Perivascular cell|Perivascular]] [[lymphocytic]] infiltrates, with [[eosinophils]] and occasional [[neutrophils]]
| colspan="2" align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Risk factors include
*Risk factors include
** Temperature changes (particularly winter)
**Temperature changes (particularly winter)
** [[Emotional stress]]
**[[Emotional stress]]
** [[Dry skin]]
**[[Dry skin]]
** Environmental irritants
**Environmental irritants
** Recent [[surgery]]
**Recent [[surgery]]
** Medications like [[topical]] antibiotic creams and [[isotretinoin]]  
**Medications like [[topical]] antibiotic creams and [[isotretinoin]]
* [[Superinfection]] with ''[[staphylococcus aureus]]''
*[[Superinfection]] with ''[[staphylococcus aureus]]''
|-
|-
! align="center" style="background:#DCDCDC;" |[[Netherton's syndrome]]<ref name="pmid10835624">{{cite journal |vauthors=Chavanas S, Bodemer C, Rochat A, Hamel-Teillac D, Ali M, Irvine AD, Bonafé JL, Wilkinson J, Taïeb A, Barrandon Y, Harper JI, de Prost Y, Hovnanian A |title=Mutations in SPINK5, encoding a serine protease inhibitor, cause Netherton syndrome |journal=Nat. Genet. |volume=25 |issue=2 |pages=141–2 |date=June 2000 |pmid=10835624 |doi=10.1038/75977 |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Netherton's syndrome]]<ref name="pmid10835624">{{cite journal |vauthors=Chavanas S, Bodemer C, Rochat A, Hamel-Teillac D, Ali M, Irvine AD, Bonafé JL, Wilkinson J, Taïeb A, Barrandon Y, Harper JI, de Prost Y, Hovnanian A |title=Mutations in SPINK5, encoding a serine protease inhibitor, cause Netherton syndrome |journal=Nat. Genet. |volume=25 |issue=2 |pages=141–2 |date=June 2000 |pmid=10835624 |doi=10.1038/75977 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | [[Autosomal recessive]] [[mutations]] in the [[SPINK5|serine protease inhibitor of Kazal type 5 gene (''SPINK5)'']]'', encoding [[LEKTI]]''[[LEKTI|, a serine protease inhibitor]]
| align="center" style="background:#F5F5F5;" |[[Autosomal recessive]] [[mutations]] in the [[SPINK5|serine protease inhibitor of Kazal type 5 gene (''SPINK5)'']]'', encoding [[LEKTI]]''[[LEKTI|, a serine protease inhibitor]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | Affects [[neonates]]
| align="center" style="background:#F5F5F5;" |Affects [[neonates]]
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Classic triad
*Classic triad
** Congenital ichthyosiform erythroderma
**Congenital ichthyosiform erythroderma
** Trichorrhexis invaginata
**Trichorrhexis invaginata
** [[Atopy|Allergic diseases]] with ↑ serum [[IgE]] levels
**[[Atopy|Allergic diseases]] with ↑ serum [[IgE]] levels
* Ichthyosis linearis circumflexa (ILC) - [[serpiginous]] [[plaques]] with double scale at the margins
*Ichthyosis linearis circumflexa (ILC) - [[serpiginous]] [[plaques]] with double scale at the margins
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Diffuse pattern
*Diffuse pattern
* Axillae,
*Axillae,
* Hair
*Hair
* Inguinal folds
*Inguinal folds
* Gluteal cleft  
*Gluteal cleft
* Groin
*Groin
* Lower legs  
*Lower legs
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Trichorrhexis invaginata (hair involvement):
*Trichorrhexis invaginata (hair involvement):
** Sparse, short, spike and brittle
**Sparse, short, spike and brittle
** "Bamboo hair" or "ball and socket deformity" of hair and eyebrows
**"Bamboo hair" or "ball and socket deformity" of hair and eyebrows
** Nodes along the hair shaft
**Nodes along the hair shaft
| align="center" style="background:#F5F5F5;" |Nl to ↑
| align="center" style="background:#F5F5F5;" |Nl to ↑


([[Eosinophilia]])
([[Eosinophilia]])
| align="center" style="background:#F5F5F5;" | ↑  
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Psoriasiform [[hyperplasia]]
*Psoriasiform [[hyperplasia]]
* Reduced granular layer
*Reduced granular layer
* Dyskeratosis  
*Dyskeratosis
* [[Dermal]] [[inflammatory]] infiltrate including [[neutrophils]] and [[eosinophils]]
*[[Dermal]] [[inflammatory]] infiltrate including [[neutrophils]] and [[eosinophils]]
| colspan="2" align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* [[Atopic diseases]] including asthma, [[atopic dermatitis]] and [[allergic rhinitis]]
*[[Atopic diseases]] including asthma, [[atopic dermatitis]] and [[allergic rhinitis]]
* Systemic and skin superinfections
*Systemic and skin superinfections
* [[Failure to thrive]]
*[[Failure to thrive]]
* Electrolyte imbalances, including [[hypernatremia]],[[dehydration]]
*Electrolyte imbalances, including [[hypernatremia]],[[dehydration]]
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
Line 376: Line 379:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infection
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infection
! align="center" style="background:#DCDCDC;" |[[Molluscum contagiosum]]
! align="center" style="background:#DCDCDC;" |[[Molluscum contagiosum]]
| align="center" style="background:#F5F5F5;" | [[Molluscum contagiosum]] virus [[inoculation]] through direct skin contact
| align="center" style="background:#F5F5F5;" |[[Molluscum contagiosum]] virus [[inoculation]] through direct skin contact
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any, peak among children >5 years of age and young adults
| align="center" style="background:#F5F5F5;" |Any, peak among children >5 years of age and young adults
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Flesh-colored, dome-shaped [[papules]] with a central umbilication
*Flesh-colored, dome-shaped [[papules]] with a central umbilication
* Lesions are 2-5mm in diameter
*Lesions are 2-5mm in diameter
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Face, trunk, [[Antecubital fossa|antecubital]],  [[Popliteal fossa|popliteal fossae]] and groin
*Face, trunk, [[Antecubital fossa|antecubital]],  [[Popliteal fossa|popliteal fossae]] and groin
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | If [[molluscum contagiosum]] is acquired as [[sexually transmitted disease]], it involves, groin and genital region.  
| align="center" style="background:#F5F5F5;" |If [[molluscum contagiosum]] is acquired as [[sexually transmitted disease]], it involves, groin and genital region.
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Keratinocytes]] containing [[eosinophilic]] [[inclusion bodies]] (Henderson-Paterson bodies)
*[[Keratinocytes]] containing [[eosinophilic]] [[inclusion bodies]] (Henderson-Paterson bodies)
* [[H&E stain]] - inwards indentation of the [[epidermis]]  
*[[H&E stain]] - inwards indentation of the [[epidermis]]
| colspan="2" align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Often [[asymptomatic]]
*Often [[asymptomatic]]
* Self resolve within 2 months  
*Self resolve within 2 months
* Immunodeficient patients present with extensive and severe infections
*Immunodeficient patients present with extensive and severe infections
* [[Molluscum contagiosum]]  lesions on the [[eyelid]] may lead to follicular or papillary [[conjunctivitis]]
*[[Molluscum contagiosum]]  lesions on the [[eyelid]] may lead to follicular or papillary [[conjunctivitis]]
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunologic disorders
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunologic disorders
! align="center" style="background:#DCDCDC;" |[[Dermatitis herpetiformis]]<ref name="pmid22137227">{{cite journal |vauthors=Kárpáti S |title=Dermatitis herpetiformis |journal=Clin. Dermatol. |volume=30 |issue=1 |pages=56–9 |date=2012 |pmid=22137227 |doi=10.1016/j.clindermatol.2011.03.010 |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Dermatitis herpetiformis]]<ref name="pmid22137227">{{cite journal |vauthors=Kárpáti S |title=Dermatitis herpetiformis |journal=Clin. Dermatol. |volume=30 |issue=1 |pages=56–9 |date=2012 |pmid=22137227 |doi=10.1016/j.clindermatol.2011.03.010 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | [[Autoimmunity|Autoimmune]] disorder as a result of [[gluten sensitivity]] leading to the formation of [[IgA]] antibodies
| align="center" style="background:#F5F5F5;" |[[Autoimmunity|Autoimmune]] disorder as a result of [[gluten sensitivity]] leading to the formation of [[IgA]] antibodies
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Any, mean age of disease onset is 2nd-4th decade
| align="center" style="background:#F5F5F5;" |Any, mean age of disease onset is 2nd-4th decade
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Excoriated [[papules]], [[plaques]] and [[vesicles]] arranged in a clustered fashion
*Excoriated [[papules]], [[plaques]] and [[vesicles]] arranged in a clustered fashion
* Symmetrical
*Symmetrical
* Erosions and excoriations  
*Erosions and excoriations
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Extensor surfaces including arms, knees, and buttocks.
*Extensor surfaces including arms, knees, and buttocks.
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Oral manifestation such as [[vesicles]] and erosion may be present
*Oral manifestation such as [[vesicles]] and erosion may be present
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Papillary]] micro-[[abscesses]]
*[[Papillary]] micro-[[abscesses]]
* Sub-epidermal [[blisters]] containing [[neutrophils]], [[eosinophils]], and [[fibrin]]  
*Sub-epidermal [[blisters]] containing [[neutrophils]], [[eosinophils]], and [[fibrin]]
* Sub-epidermal [[vacuolization]]  
*Sub-epidermal [[vacuolization]]
| colspan="2" align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Intermittent [[Itch|pruritic]] [[papules]] and [[vesicles]]
*Intermittent [[Itch|pruritic]] [[papules]] and [[vesicles]]
* [[Celiac disease]] with [[Villous folds|villous]] atrophy and [[Crypt (anatomy)|crypt]] [[hyperplasia]]  
*[[Celiac disease]] with [[Villous folds|villous]] atrophy and [[Crypt (anatomy)|crypt]] [[hyperplasia]]
* Abdominal [[bloating]], pain, [[Diarrheal|diarrhea]], or [[constipation]]  
*Abdominal [[bloating]], pain, [[Diarrheal|diarrhea]], or [[constipation]]
|-
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immune deficiency
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immune deficiency
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wiskott-Aldrich syndrome]]<ref name="pmid24817816">{{cite journal |vauthors=Buchbinder D, Nugent DJ, Fillipovich AH |title=Wiskott-Aldrich syndrome: diagnosis, current management, and emerging treatments |journal=Appl Clin Genet |volume=7 |issue= |pages=55–66 |date=2014 |pmid=24817816 |pmc=4012343 |doi=10.2147/TACG.S58444 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wiskott-Aldrich syndrome]]<ref name="pmid24817816">{{cite journal |vauthors=Buchbinder D, Nugent DJ, Fillipovich AH |title=Wiskott-Aldrich syndrome: diagnosis, current management, and emerging treatments |journal=Appl Clin Genet |volume=7 |issue= |pages=55–66 |date=2014 |pmid=24817816 |pmc=4012343 |doi=10.2147/TACG.S58444 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Mutation in the gene encoding for [[Wiskott-Aldrich syndrome]] protein (WASp) on the short arm of the [[X chromosome]]
*Mutation in the gene encoding for [[Wiskott-Aldrich syndrome]] protein (WASp) on the short arm of the [[X chromosome]]
* [[X linked inheritance|X-linked disorder]]
*[[X linked inheritance|X-linked disorder]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | Seen almost exclusively in males in infancy
| align="center" style="background:#F5F5F5;" |Seen almost exclusively in males in infancy
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Rash is clinically similar to [[atopic dermatitis]]
*Rash is clinically similar to [[atopic dermatitis]]
* [[Erythematous]] and [[Itch|pruritic]] lesions
*[[Erythematous]] and [[Itch|pruritic]] lesions
* Lesions can bleed due to [[thrombocytopenia]]
*Lesions can bleed due to [[thrombocytopenia]]
* Cutaneous manifestations includes [[Petechia|petechiae]] and [[ecchymosis]]
*Cutaneous manifestations includes [[Petechia|petechiae]] and [[ecchymosis]]
| align="center" style="background:#F5F5F5;" | Rash can involve lesions located at the same areas of classical atopic dermatitis:
| align="center" style="background:#F5F5F5;" |Rash can involve lesions located at the same areas of classical atopic dermatitis:


extensor surfaces of extremities and cheeks or scalp
extensor surfaces of extremities and cheeks or scalp
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | Infants can present with [[petechiae]], prolonged [[bleeding]] from [[umbilicus]] or circumcision,  [[purpura]],[[hematemesis]], [[melena]], [[epistaxis]], [[hematuria]]  or unusal bruising
| align="center" style="background:#F5F5F5;" |Infants can present with [[petechiae]], prolonged [[bleeding]] from [[umbilicus]] or circumcision,  [[purpura]],[[hematemesis]], [[melena]], [[epistaxis]], [[hematuria]]  or unusal bruising
| align="center" style="background:#F5F5F5;" |Nl to ↑
| align="center" style="background:#F5F5F5;" |Nl to ↑


([[Eosinophilia]])
([[Eosinophilia]])
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Hyperkeratosis]]
*[[Hyperkeratosis]]
* Psoriasiform [[hyperplasia]]
*Psoriasiform [[hyperplasia]]
* Dyskeratosis
*Dyskeratosis


* Epidermal psoriasiform [[hyperplasia]]
*Epidermal psoriasiform [[hyperplasia]]
* Marked intercellular [[edema]] with spongiotic vesiculation
*Marked intercellular [[edema]] with spongiotic vesiculation
| colspan="2" align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* ↑ serum [[IgA]] levels  
*↑ serum [[IgA]] levels
* ↑ serum [[IgE]] levels
*↑ serum [[IgE]] levels
* Bleeding: severe [[thrombocytopenia]],
*Bleeding: severe [[thrombocytopenia]],
* [[Eczema]] - similar to [[atopic dermatitis]]
*[[Eczema]] - similar to [[atopic dermatitis]]
* Recurrent sino-pulmonary infections
*Recurrent sino-pulmonary infections
* [[Opportunistic infection|Opportunistic infections.]]
*[[Opportunistic infection|Opportunistic infections.]]
* [[Autoimmune diseases]]
*[[Autoimmune diseases]]
* [[Malignancies]]
*[[Malignancies]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hyper-IgE syndrome]]<ref name="pmid24058807">{{cite journal |vauthors=Mogensen TH |title=STAT3 and the Hyper-IgE syndrome: Clinical presentation, genetic origin, pathogenesis, novel findings and remaining uncertainties |journal=JAKSTAT |volume=2 |issue=2 |pages=e23435 |date=April 2013 |pmid=24058807 |pmc=3710320 |doi=10.4161/jkst.23435 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hyper-IgE syndrome]]<ref name="pmid24058807">{{cite journal |vauthors=Mogensen TH |title=STAT3 and the Hyper-IgE syndrome: Clinical presentation, genetic origin, pathogenesis, novel findings and remaining uncertainties |journal=JAKSTAT |volume=2 |issue=2 |pages=e23435 |date=April 2013 |pmid=24058807 |pmc=3710320 |doi=10.4161/jkst.23435 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Defects in the [[JAK-STAT signaling pathway]] leading to dysfunctional [[T helper cell]] type 17 ([[T helper 17 cell|Th17]]) [[differentiation]]
*Defects in the [[JAK-STAT signaling pathway]] leading to dysfunctional [[T helper cell]] type 17 ([[T helper 17 cell|Th17]]) [[differentiation]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | Rare, begin in infancy  
| align="center" style="background:#F5F5F5;" |Rare, begin in infancy
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Papulopustular
*Papulopustular
* Severely [[Itch|pruritic]] eczematous rash  
*Severely [[Itch|pruritic]] eczematous rash
* [[Pustular rash|Pustular]] and may impetiginized
*[[Pustular rash|Pustular]] and may impetiginized
* [[Lichenification]] may occur
*[[Lichenification]] may occur
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Face and scalp
*Face and scalp
* Upper trunk and shoulders  
*Upper trunk and shoulders
* Buttocks
*Buttocks
* Area behind the ears and around the hairline
*Area behind the ears and around the hairline
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Characteristic coarse facies
*Characteristic coarse facies
* Increased alar width and broad [[nasal bridge]]
*Increased alar width and broad [[nasal bridge]]
* High-arched oral palate
*High-arched oral palate
* Hyperextensible joints  
*Hyperextensible joints
| align="center" style="background:#F5F5F5;" |Nl to ↑
| align="center" style="background:#F5F5F5;" |Nl to ↑


([[Eosinophilia]])
([[Eosinophilia]])
| align="center" style="background:#F5F5F5;" | ↑  
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Eosinophil]]-rich infiltration around the hair follicles
*[[Eosinophil]]-rich infiltration around the hair follicles
| colspan="2" align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Cold [[abscesses]]
*Cold [[abscesses]]


* [[Itch|Pruritic]] [[eczema]]
*[[Itch|Pruritic]] [[eczema]]
* [[Allergy|Allergic]] diseases
*[[Allergy|Allergic]] diseases
* Noneruption of permanent teeth
*Noneruption of permanent teeth
* Multiple bone [[Bone fracture|fractures]] and scoliosisis
*Multiple bone [[Bone fracture|fractures]] and scoliosisis
* [[Peripheral T-cell lymphomas|Peripheral T-cell lymphoma]]
*[[Peripheral T-cell lymphomas|Peripheral T-cell lymphoma]]
* [[Coronary artery]] [[aneurysms]]
*[[Coronary artery]] [[aneurysms]]
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Malignancy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Malignancy
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mycosis fungoides]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mycosis fungoides]]
| align="center" style="background:#F5F5F5;" | Clonal expansion of [[CD4+ cell|CD4]]<sup>+</sup> [[memory T cells]] (CD45RO<sup>+</sup>)
| align="center" style="background:#F5F5F5;" |Clonal expansion of [[CD4+ cell|CD4]]<sup>+</sup> [[memory T cells]] (CD45RO<sup>+</sup>)
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Mean age is  55- 60 years
| align="center" style="background:#F5F5F5;" |Mean age is  55- 60 years
| align="center" style="background:#F5F5F5;" | Multiple
| align="center" style="background:#F5F5F5;" |Multiple
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Non-pruritic patches and intensely [[Itch|pruritic]] [[plaques]]  
*Non-pruritic patches and intensely [[Itch|pruritic]] [[plaques]]
* [[Comedones]], [[cysts]]
*[[Comedones]], [[cysts]]
* [[Tumors]] of skin
*[[Tumors]] of skin
* [[Erythematous]] [[macules]]
*[[Erythematous]] [[macules]]
* [[Hypopigmented area|Hypopigmented]] patches  
*[[Hypopigmented area|Hypopigmented]] patches
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Asymmetrical
*Asymmetrical
* Hips, groin and trunk
*Hips, groin and trunk
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Alopecia]]
*[[Alopecia]]
* [[Acneiform eruption|Acneiform]] lesions
*[[Acneiform eruption|Acneiform]] lesions
* [[Plaques]] size can vary between 2-20 cm
*[[Plaques]] size can vary between 2-20 cm
* [[Lymphadenopathy]]
*[[Lymphadenopathy]]
* Children-  [[Hypopigmentation|hypopigmented]] patches most common
*Children-  [[Hypopigmentation|hypopigmented]] patches most common
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Perifollicular infiltrates around the [[infundibulum]]  
*Perifollicular infiltrates around the [[infundibulum]]
* [[Epidermis]] is spared or has minimal spongiosis
*[[Epidermis]] is spared or has minimal spongiosis
* Band-like [[Dermal|derma]]<nowiki/>l infiltrate of [[lymphocytes]] and and [[histiocytes]]
*Band-like [[Dermal|derma]]<nowiki/>l infiltrate of [[lymphocytes]] and and [[histiocytes]]
| colspan="2" align="center" style="background:#F5F5F5;" |
| colspan="2" align="center" style="background:#F5F5F5;" |
* Increased risk of :
*Increased risk of :
** Severe viral and bacterial infections
**Severe viral and bacterial infections
** Secondary [[malignancies]], especially lymphomas
**Secondary [[malignancies]], especially lymphomas
* Staging of [[Mycosis fungoides]] is based upon:
*Staging of [[Mycosis fungoides]] is based upon:
** Patches
**Patches
** [[Plaques]]
**[[Plaques]]
** Skin tumors
**Skin tumors
** [[Lymphadenopathy]]
**[[Lymphadenopathy]]
** [[Erythroderma]]
**[[Erythroderma]]
** [[Histology]]
**[[Histology]]
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inherited
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquired
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Single/
Multiple
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Rash
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Involved areas
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pustule
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Itching
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum IgE
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated factors
|}
|}


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[[Category:Autoimmune diseases]]
[[Category:Dermatology]]
[[Category:Dermatology]]
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Latest revision as of 02:44, 16 October 2021

Atopic dermatitis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD; Shalinder Singh, M.B.B.S.[2]

Overview

Atopic dermatitis is a chronic inflammatory skin disorder, which is indistinguishable from other causes of dermatitis. Atopic dermatitis is usually associated with personal or family history of atopic diseases including asthma, allergic rhinitis and food allergy. The most common clinically similar dermatitis in infancy is seborrheic dermatitis which includes hyperkeratosis of the scalp, also found in atopic dermatitis.

Atopic Dermatitis from other Diseases

Atopic dermatitis should be differentiated from allergic contact dermatitis, iirritant contact dermatitis, seborrheic dermatitis, psoriasis, lichen simplex chronicus, ichthyosis vulgaris, nummular dermatitis (discoid eczema), netherton's syndrome, and dermatitis herpetiformis

Category Diseases Etiology Inherited Acquired Clinical manifestations Para-clinical findings Associated factors
Demography Symptoms Physical examination
Lab Findings Histopathology
Appearance Itching Fever Tenderness Other Eosinophils Serum IgE
Single/

Multiple

Rash Involved areas Pustule
Skin disorders Atopic dermatitis
  • Epidermal barrier dysfunction
  • Immune dysregulation
+ + Multiple
  • Young children -Scalp, cheeks amd extensor surface
  • Adolescents -flexural areas and buttock-thigh creases
  • Adults - facial involvement and skin flexures
+
  • Infra-auricular and retro-auricular fissuring
  • Nipple eczema
  • White dermographism
  • Perifollicular accentuation
Nl to ↑

(Eosinophilia)

  • Epidermal psoriasiform hyperplasia
  • Marked intercellular edema with spongiotic vesiculation
Allergic contact dermatitis[1] + Any May be multiple after 1-2 days of exposure Erythematous well-demarcated papules Surrounding the area in contact with the offending agent + + Nl to ↑

(Eosinophilia)

Nl
Irritant contact dermatitis[2] + Any, more with occupational exposure Usually single immediately after the exposure Well-demarcated red patch with a glazed surface Any area in contact with the irritant + + Nl Nl
  • Cumulative exposure to irritants
  • Negative hypersensitivity tests
Seborrheic dermatitis
  • Not known
+ Any, onset during the infancy and peak during 3rd-4th decades Multiple
  • Cradle cap - yellowish scales on the scalp
  • Patchy or diffuse greasy scaling with or without a yellow-red base
  • Crusts
Scalp, face, trunk, postauricular, diaper area and axilla + +
  • Infants:
    • Cradle cap (Sclap) - non-inflammatory greasy scales on the scalp
    • Asymptomatic
    • Self resolving
Nl Nl Risk factors include

Generalized seborrheic erythroderma in immunodeficient patients

Psoriasis + + Any, 2 peaks of onset 30-39 years and 50-59 years Multiple Well-circumscribed, pink papules and symmetrically distributed cutaneous plaques with silvery scales
  • Scalp
  • Trunk
  • Gluteal cleft
  • Extensor surface of elbows and knees
+ + _ + Nl Nl Risk factors include
Lichen simplex [3]chronicus + Any, peak at 30-50 years of age Multiple Lichenified and erythematous, pruritic exudative plaque, and excoriations Scalp, head, neck, hands, arms, and genitals areas +
  • Color of plaque varies from yellow to reddish-brown
  • Plaque size can vary between 3X6 cm 6X10 cm areas.
Nl Nl Risk factors include
Ichthyosis vulgaris[4] + + Usually in infancy Multiple
  • Extensor surfaces of the extremities
  • Scalp
  • Trunk
  • Scales can vary from mild scaling to large, plate (armor)-like scales and thickening of the skin.
Nl Nl
Nummular dermatitis (discoid eczema) Unknown + Any, two peaks, 6th-7th decade of life in males and 2nd-3rd decade of life in females Multiple
  • Symmetrical coin-shaped erythematous plaques
  • Erosions and excoriations
  • Chronic lesions- central clearing leading to annular lesions
  • Upper and lower extremities
  • Lower trunk
+
  • Chronically lesions result into central clearing leading to annular lesions.
Nl Nl
Netherton's syndrome[5] Autosomal recessive mutations in the serine protease inhibitor of Kazal type 5 gene (SPINK5), encoding LEKTI, a serine protease inhibitor + Affects neonates Multiple
  • Classic triad
    • Congenital ichthyosiform erythroderma
    • Trichorrhexis invaginata
    • Allergic diseases with ↑ serum IgE levels
  • Ichthyosis linearis circumflexa (ILC) - serpiginous plaques with double scale at the margins
  • Diffuse pattern
  • Axillae,
  • Hair
  • Inguinal folds
  • Gluteal cleft
  • Groin
  • Lower legs
+ +
  • Trichorrhexis invaginata (hair involvement):
    • Sparse, short, spike and brittle
    • "Bamboo hair" or "ball and socket deformity" of hair and eyebrows
    • Nodes along the hair shaft
Nl to ↑

(Eosinophilia)

Diseases Etiology Inherited Acquired Demography Single/

Multiple

Rash Involved areas Pustule Itching Fever Tenderness Other WBC Serum IgE Histopathology Associated factors
Infection Molluscum contagiosum Molluscum contagiosum virus inoculation through direct skin contact + Any, peak among children >5 years of age and young adults Multiple
  • Flesh-colored, dome-shaped papules with a central umbilication
  • Lesions are 2-5mm in diameter
+ If molluscum contagiosum is acquired as sexually transmitted disease, it involves, groin and genital region. Nl Nl
Immunologic disorders Dermatitis herpetiformis[6] Autoimmune disorder as a result of gluten sensitivity leading to the formation of IgA antibodies + Any, mean age of disease onset is 2nd-4th decade Multiple
  • Excoriated papules, plaques and vesicles arranged in a clustered fashion
  • Symmetrical
  • Erosions and excoriations
  • Extensor surfaces including arms, knees, and buttocks.
+
  • Oral manifestation such as vesicles and erosion may be present
Nl Nl
Immune deficiency Wiskott-Aldrich syndrome[7] + Seen almost exclusively in males in infancy Multiple Rash can involve lesions located at the same areas of classical atopic dermatitis:

extensor surfaces of extremities and cheeks or scalp

+ Infants can present with petechiae, prolonged bleeding from umbilicus or circumcision, purpura,hematemesis, melena, epistaxis, hematuria or unusal bruising Nl to ↑

(Eosinophilia)

  • Epidermal psoriasiform hyperplasia
  • Marked intercellular edema with spongiotic vesiculation
Hyper-IgE syndrome[8] + Rare, begin in infancy Multiple
  • Face and scalp
  • Upper trunk and shoulders
  • Buttocks
  • Area behind the ears and around the hairline
+ +
  • Characteristic coarse facies
  • Increased alar width and broad nasal bridge
  • High-arched oral palate
  • Hyperextensible joints
Nl to ↑

(Eosinophilia)

  • Eosinophil-rich infiltration around the hair follicles
Malignancy Mycosis fungoides Clonal expansion of CD4+ memory T cells (CD45RO+) + Mean age is 55- 60 years Multiple
  • Asymmetrical
  • Hips, groin and trunk
+ Nl Nl

References

  1. Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF (2009). "Allergic and irritant contact dermatitis". Eur J Dermatol. 19 (4): 325–32. doi:10.1684/ejd.2009.0686. PMID 19447733.
  2. Bains SN, Nash P, Fonacier L (October 2018). "Irritant Contact Dermatitis". Clin Rev Allergy Immunol. doi:10.1007/s12016-018-8713-0. PMID 30293200.
  3. Voicu C, Tebeica T, Zanardelli M, Mangarov H, Lotti T, Wollina U, Lotti J, França K, Batashki A, Tchernev G (July 2017). "Lichen Simplex Chronicus as an Essential Part of the Dermatologic Masquerade". Open Access Maced J Med Sci. 5 (4): 556–557. doi:10.3889/oamjms.2017.133. PMC 5535688. PMID 28785363.
  4. Thyssen JP, Godoy-Gijon E, Elias PM (June 2013). "Ichthyosis vulgaris: the filaggrin mutation disease". Br. J. Dermatol. 168 (6): 1155–66. doi:10.1111/bjd.12219. PMID 23301728.
  5. Chavanas S, Bodemer C, Rochat A, Hamel-Teillac D, Ali M, Irvine AD, Bonafé JL, Wilkinson J, Taïeb A, Barrandon Y, Harper JI, de Prost Y, Hovnanian A (June 2000). "Mutations in SPINK5, encoding a serine protease inhibitor, cause Netherton syndrome". Nat. Genet. 25 (2): 141–2. doi:10.1038/75977. PMID 10835624.
  6. Kárpáti S (2012). "Dermatitis herpetiformis". Clin. Dermatol. 30 (1): 56–9. doi:10.1016/j.clindermatol.2011.03.010. PMID 22137227.
  7. Buchbinder D, Nugent DJ, Fillipovich AH (2014). "Wiskott-Aldrich syndrome: diagnosis, current management, and emerging treatments". Appl Clin Genet. 7: 55–66. doi:10.2147/TACG.S58444. PMC 4012343. PMID 24817816.
  8. Mogensen TH (April 2013). "STAT3 and the Hyper-IgE syndrome: Clinical presentation, genetic origin, pathogenesis, novel findings and remaining uncertainties". JAKSTAT. 2 (2): e23435. doi:10.4161/jkst.23435. PMC 3710320. PMID 24058807.