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LEARNING OBJECTIVES

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After completing this case study, students should be able to:

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  • Understand risk factors and aggravating factors in the pathophysiology of atopic dermatitis.

  • Understand the treatment strategies for atopic dermatitis, including nonpharmacologic management.

  • Educate patients and/or their caregivers about management of atopic dermatitis.

  • Monitor the safety and efficacy of selected pharmacologic therapies.

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PATIENT PRESENTATION

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Chief Complaint

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As stated by the patient’s mother, “My child constantly wants to scratch her skin, and she can’t sleep well during the night.”

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HPI

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Julia Chan is a 3.5-year-old girl who just started attending daycare about 1 month ago. She did not want to go and still exhibits a lot of clinging behavior when her mother tries to leave; she still cries when her mother eventually does manage to leave. Her mother says that Julia’s atopic dermatitis has flared up again. Julia has had atopic dermatitis since she was about 6 months old. It had been well controlled by topical corticosteroids and liberal use of moisturizers. Her recent flare-up began about 2–3 weeks ago. She has not been sleeping well and is constantly trying to scratch her skin at night. Her mother has been using 100% cotton sheets for her bed since she was an infant. She has sewn mittens on Julia’s 100% cotton pajamas to prevent her from scratching, because she had previously caused excoriations from scratching, which then became infected. During the day, Julia constantly wants to scratch her skin but has been told to just “pat” the itchy area. The caregivers at the daycare center keep an eye on her scratching behavior as well but are not always able to prevent her from scratching herself. They also inform her mother that Julia likes to eat food shared by other children.

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PMH

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Julia was breastfed from birth for a total of 8 weeks, when her mother decided to return to work. Julia was then cared for at home by a babysitter and fed cow’s milk, with oatmeal cereal being introduced as the first solid food. She was fed some lemon meringue pie (made with egg white) once, and developed generalized hives, which led to the recognition that Julia has an egg allergy. This was confirmed by allergic skin testing. Julia’s atopic dermatitis presented at 6 months of age. The parents have recently become aware that the babysitter left Julia alone a lot (sitting on the floor/carpet to play by herself). That was the major reason for sending Julia to a daycare center.

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SH

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Julia is the only child of a professional couple. Her father is an engineer and her mother is a litigation lawyer who often works long hours. The couple has a stressful lifestyle, and it appears that the stress is reflected in Julia’s care. Sometimes Julia would be ...

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