Neglected Tropical Diseases of the Skin
ATOPIC DERMATITIS with focus on
Sub-Saharan Africa
Training for national and district-level
health workers
ABOUT THIS COURSE
Introduction to Neglected Tropical Diseases
Module into
Introduction 1: Atopic Dermatitis and Skin NTDs
Atopic Dermatitis in Sub-Saharan Africa
Common Skin Diseases in Sub-Saharan Africa
Module 2: Diagnosis Criteria of Atopic Dermatitis according to Age
Common Skin Diseases to Differentiate from Atopic Dermatitis
Infectious Complications of Atopic Dermatitis
Module 3: Non-Infectious Complications of Atopic Dermatitis
Social Stigma of Atopic Dermatitis
Basic Treatment and Management of Atopic Dermatitis
Module 4 The don’ts about skin care in atopic dermatitis
Step by step learning essentials of basic therapy
Understanding the Cause of Atopic Dermatitis
Module 5: Atopic Dermatitis and Allergies
Minimizing Atopic Dermatitis Risk
Assessment of Diagnosis and Lack of Response to First
Module 6: Managing the Patient with Progressive/Rapid Aggravation
Special Locations of Atopic Dermatitis and Others Pearls
LEARNING OBJECTIVES – ATOPIC DERMATITIS
the common features of atopic dermatitis among
DESCRIBE
communities screened for NTDs
DESCRIBE the clinical presentation and diagnosis of atopic dermatitis
OUTLINE the basic therapeutic management plan for atopic
dermatitis
the complications of severe atopic dermatitis and how to
LIST minimize this risk
MODULE 3
MODULE OVERVIEW
Part 1: Infectious Complications of Atopic Dermatitis
Part 2: Non-Infectious Complications of Atopic Dermatitis
Part 3: Social Stigma of Atopic Dermatitis
Atopic Dermatitis
MODULE 3
PART 1
Infectious Complications of Atopic Dermatitis
Atopic Dermatitis
Infectious Complications of Atopic Dermatitis
Skin Infections: The constant itching
and scratching associated with atopic
dermatitis leads to breaks in the skin,
making it more susceptible to bacterial,
viral, or fungal infections. Common
infections include impetigo (bacterial),
herpes simplex (viral), and more rarely
fungal infections like tinea (ringworm).
The systemic risk of bacterial and viral
Crusted impetigo associated with
infections is certain but poorly excoriated lesions of AD in a child
appreciated in SSA. Credit: O Faye
Atopic Dermatitis
Bacterial Infections
- Atopic dermatitis causes damage to the skin, allowing bacteria like S. aureus to
enter and cause a localized infection (impetigo, folliculitis)
- When a patient presents with vesiculobullous, crusted, oozing lesions
suggesting impetigo the reflex should be to look for a primary cause such as
scabies or atopic dermatitis
- Rarely, bacterial superinfection may lead to systemic complications such as
septicemia, osteomyelitis, or post streptococcal glomerulonephritis
- Thus, it is important to detect and treat rapidly pyoderma independently of
its primary cause
Atopic Dermatitis
Bacterial Infections (Cont’d)
Vesiculobullous lesions
of acute bacterial
superinfection on atopic
dermatitis
Credit: M. Ball
Atopic Dermatitis
Bacterial Infections (Cont’d)
The involvement of the
auricular
fold is common in children
with AD.
The rapid change with
bullous
and crusted lesions
suggests
impetigo
Credit: M. Ball
Atopic Dermatitis
Bacterial Infections (Cont’d)
Left untreated, impetigo on
AD becomes deeper,
ulcerative and is named
ecthyma.
Il may progress to cellulitis,
lymphangitis and abscesses.
Secondary chronic
disfiguring hypochromia is
common on black skin.
Credit: M. Ball
Atopic Dermatitis
Treatment of Bacterial Infections
• MILD CASES: local antibiotics such as mupirocin or fusidic acid, under supervision
• SEVERE CASES: If the infection has spread extensively, oral antibiotics may be
necessary .
• Oral amoxicillin-clavulanate is the most commonly prescribed antibiotic
• Adults: One 500 mg tablet every 12 hours.
• Children:
• Mild-to-moderate skin and soft tissue infections
• 25 mg/kg per day in divided doses every 12 hours OR
• 20 mg/kg per day in divided doses every 8 hours.
• Severe skin and soft tissue infections:
• 45 mg/kg per day in divided doses every 12 hours OR
• 40 mg/kg per day in divided doses every 8 hours.
• Duration: 7-10 days and at least 48-72 hours after patient is asymptomatic or
after evidence of bacterial eradication
Atopic Dermatitis
Viral Infections
• The major risk in atopic dermatitis is superinfection by herpes
simplex virus (HSV).
• This is a severe and potentially life-threatening complication that
occurs when HSV infects the compromised skin of individuals with
atopic dermatitis.
• It manifests as widespread painful blisters or ulcers that can rapidly
spread and become systemic.
• Other widespread skin superinfections may occur with:
o the smallpox vaccine (eczema vaccinatum)
o coxsackie viruses which cause hand foot and mouth disease.
Atopic Dermatitis
Viral Infections (Cont’d)
Primary HSV infection
with lingual and
perioral lesions
Credit: A. Taieb
Atopic Dermatitis
Viral Infections (Cont’d)
Credit: A. Taieb
Sudden exacerbation of lichenified AD lesions with vesicles and punched out erosions
Atopic Dermatitis
Viral Infections (Cont’d)
Note the symmetrical Involvement
Credit: A. Taieb
on chronically scratched lesions,
suggesting dissemination by auto-
inoculation
Credit: A. Taieb
Atopic Dermatitis
Viral Infections (Cont’d)
Eczema herpeticum in a baby, with large pustules and eye involvement needing urgent
treatment. Credits: [Link]
Atopic Dermatitis
Treatment of Viral Infections
• Eczema herpeticum requires immediate medical attention as it can lead
to complications such as bacterial superinfections, disseminated viral
infection, or even sepsis. Complications such as pneumonia or
encephalitis are possible.
• The primary treatment for eczema herpeticum is antiviral medication,
usually administered orally or intravenously. The most commonly used
antiviral agents are acyclovir, valacyclovir, or famciclovir.
• The specific dosage and duration of antiviral therapy depend on the
severity of the infection and the individual's overall health.
The possibility of a bacterial co-infection may also need treat
simultaneously with available antibiotics
Atopic Dermatitis
MODULE 3
PART 2
Non-Infectious Complications of Atopic
Dermatitis
Atopic Dermatitis
Non-Infectious Complications of Atopic Dermatitis
Side effects of treatments
• In the context of SSA, the most
important side effects to
consider are systemic and
topical steroids.
• Long term use of topical
steroids can cause skin thinning
Striae distensae after chronic treatment
while long term use of oral
of adult AD with potent topical
steroids can cause stretch corticosteroids
marks, weight gain, and Credit: Aoki-Orfali, Takaoka-Samorano
metabolic issues.
Atopic Dermatitis
Non-Infectious Complications of Atopic Dermatitis
(Cont’d)
Erythroderma complicating
herbal therapy given by
traditional healer for atopic
dermatitis
Credit: M. Ball
Atopic Dermatitis
Non-Infectious Complications of Atopic Dermatitis
(Cont’d)
Allergic Contact Dermatitis
• People with atopic dermatitis have
a higher risk of developing allergic
contact dermatitis, which occurs
when the skin meets substances
that trigger an allergic reaction.
• These substances can include
certain metals (e.g., nickel),
fragrances, preservatives,
antibiotics, or chemicals.
Contact dermatitis with secondary hyperpigmentation
due to lipstick
Credit: N. Dlova
Atopic Dermatitis
Non-Infectious Complications of Atopic Dermatitis
(Cont’d)
Severe facial contact
dermatitis
presenting with itching
erythema and edema
Credit: M. Ball
Atopic Dermatitis
Non-Infectious Complications of Atopic Dermatitis
(Cont’d)
Nickel dermatitis
following earring piercing
Credit: M. Ball
Atopic Dermatitis
Non-Infectious Complications of Atopic Dermatitis
(Cont’d)
• Asthma and Allergies: Atopic dermatitis is part of a group of allergic
conditions known as the atopic triad, which also includes asthma and
allergic rhinitis (hay fever).
• While not everyone with atopic dermatitis develops these conditions,
there is an increased risk of developing asthma or allergies in
individuals with atopic dermatitis, especially if there is a family history
of these conditions.
Atopic Dermatitis
Non-Infectious Complications of Atopic Dermatitis
(Cont’d)
Sleep Disturbances
• Atopic dermatitis often causes intense itching, especially at night.
• The itchiness can make it challenging to fall asleep or maintain a
sound sleep, resulting in daytime fatigue and reduced quality of life.
Atopic Dermatitis
MODULE 3
PART 3
Social Stigma of Atopic Dermatitis
Atopic Dermatitis
Main Complications of Atopic Dermatitis
Stigma and psychosocial impact
• Chronic inflammation and repeated scratching can
cause changes in skin pigmentation, leading to
darkening or lightening of the affected areas.
• In severe cases, prolonged scratching can result in
scarring, which may persist even after the resolution
of active dermatitis.
Persistent stigma in a child after atopic dermatitis
resulting in scarring and hypopigmentation of the
face.
Credit: M Ball
Atopic Dermatitis
Main Complications of Atopic Dermatitis (Cont’d)
• The visible appearance of when it
affects highly visible areas like the face,
can lead to self-consciousness,
embarrassment, and lowered self-
esteem.
• People with atopic dermatitis may
experience social and psychological
difficulties due to the condition,
including anxiety and depression.
Hypopigmentation in Hyperpigmentation in
adult atopic dermatitis adult atopic dermatitis
prurigo type prurigo type
Credit: N. Dlova Credit: N. Dlova
Atopic Dermatitis Course Developers
Module 3
Alain Taieb, MD, PhD, University of Bordeaux, Bordeaux, France
Ncoza Dlova, MD, University of Kwa Zulu Nadal, Durban , South Africa
Mamadou Ball, MD, University of Nouakchott, Nouakchott, Mauritania
Andreas Wollenberg, MD, PhD, University Hospital Augsburg, LMU Munich, Germany
Edited with support from:
Esther Freeman, MD, PhD, MGH Department of Dermatology, Boston, USA
Jadesola Akinwuntan, BS, MGH Department of Dermatology, Boston, USA
THANK YOU