What are the possible complications of atopic dermatitis (AD)?

Updated: Apr 26, 2021
  • Author: Cassandra Bradby, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Excoriations secondary to itch predispose to infection and can be recognized by the accumulation of serum, crust, and purulent material. Development of vesicle and/or pustules in patients with known atopic dermatitis should initiate a search for bacterial or viral superinfection; appropriate antibiotics or antivirals should be started immediately. Patients with atopic dermatitis are uniquely susceptible to herpes simplex, which may occasionally progress to a Kaposi’s varicelliform eruption; physicians and patients should be particularly vigilant for this condition. This rare complication is characterized by generalized involvement, systemic toxicity, and even death. In these cases, the patient should be treated with oral acyclovir and monitored closely. Topical corticosteroids and/or occlusive dressings are best, at least temporarily, discontinued.

Exfoliative erythroderma is another rare complication, occurring in less than 1% of patients with atopic dermatitis. Exfoliative erythroderma demonstrates a marked progression caused by widespread Staphylococcus aureus or herpes simplex superinfection and can be life threatening if it is complicated by high-output cardiac failure and heat loss.

Atrophy or striae occur if fluorinated corticosteroids are used on the face or in skin folds.

Systemic absorption of steroids may occur if large areas of skin are treated, particularly if high-potency medications and occlusion are combined.

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