Atopic Dermatitis

A neonate was seen in consultation when brought to the emergency department because of parental concern about a facial rash. The rash had been present since the baby was 2 weeks old. The baby had been “fidgety,” feeding poorly, and rarely sleeping through the night. The mother had lifelong asthma.

Key point: This distribution of an inflammatory disorder in a very young child almost always indicates atopic dermatitis. The family history of asthma suggests the atopic diathesis.

Treatment: Application of both a bland ceramide-based moisturizer and mild corticosteroid were instituted, with resolution of the facial eruption.

Note: This child may benefit from dietary restriction (ie, avoiding highly antigenic foods), and is certainly at risk for asthma and seasonal rhinitis later in life.