Atopic dermatitis

QUESTION 1

An 11-year-old girl presents to the pediatric dermatology clinic as a referral for a persistently itchy rash that involves the face, neck, trunk and extremities. She has been treated by her pediatrician for atopic dermatitis (AD). The pediatrician has been treating the areas with topical hydrocortisone 2.5% cream, which has not helped control the symptoms. Her mother states that despite using generous emollients and hydrocortisone, the girl scratches rigorously at night and is unable to concentrate during school due to pruritus. She has a past medical history of moderate intermittent asthma and allergic rhinitis, and her mother reports a strong history of asthma on her side of the family without any dermatologic issues. On physical examination, there is extensive generalized xerosis of the skin with areas of eczematous lichenified plaques, many with secondary excoriations and hypopigmentation (1).