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An infant presented with erythematous lesions on cheek, extensor aspect of limbs, mother has history of bronchial asthma, the probable diagnosis is - (AIIMS May 2013)

A Air borne contact dermatitis

B Atopic dermatitis

C Seborraehic dermatitis

D Infectious eczematoid dermatitis

Ans. A
i.e., Atopic dermatitis

Differential Diagnosis of Dermatitis in Infants

Atopic dermatitis (Infantile form. i.e. Infantile eczematous dermatitis)

a. Starts at the age of 2-3 months

b. Itchy papules and vesicles, lesions are intensively prurititic

c. Distribution àBegins on face but can involve rest of the body, sparing diaper area (napkin rash is absent)

d. After face, neck and extensor surfaces (of knee, elbow) and groin are involved

e. Personal or family history of other atopic conditions àAsthma, Haye fever, allergic rhinitis or conjunctivitis, urticaria, food allergies.

Infantile seborrheic dermatitis

a. Begins in infants <3 months of age

b. Most commonly presents as cradle cap (yellowish-pink thick scales with slight erythma on scalp à erythmatous scaly lesions)

c. Besides scalp (the most common sitE. other sites involved are, major flexures fold (groin, axillA., facial flexures (creases of cheeks, nosal folds), and other hairy sites. Lesion may extend over diaper area (napkin rash may occur)

d. Severe dandruff

Napkin dermatitis (erosive napkin dermatitis)

a. It is due to persistent contact of napkin area with urine and feces as a result of infrequent change in napkins.

b. Dermatitis, i.e. erythmatous (reD. fissured & eroded lesions on napkin or diaper area (rounded contour of buttock)

c. Flexural areas are shared.

d. Ammonical smell (ureolytic bacteria from anal area act on urine and produce ammoniA.

Xerotic eczema (xerotic dermatitis)

a. Patches of dry erythma and fine scales

b. Distribution ~ Cheeks and extensors of extremities

c. Worsen in winter and with use of a soap.

Now see the Question

a. Information in this question are:-

i. Patient is infant

ii. Erythematous lesion on cheeks and extensors

iii. The most important is family history of Asthma in mother (This single information can rule out other three options).

b. I think, you dont have any doubt, diagnosis is atopic dermatitis in infantile stage, i.e. Infantile eczematous dermatitis.

c. Note - In option D. there is Infectious eczematous dermatitis (not Infantile eczematous dermatitis).

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