Lichenified lesions

Cool wet dressings or total body wraps placed directly onto the skin can be effective in relieving itching, particularly at night. Wet wraps used in conjunction with topical corticosteroids can be used for acute flares or chronic, lichenified lesions." " Skin maceration, fissures, and subsequent infections can occur, and thus these occlusive dressings should be limited to severe, chronic lesions. Tepid compresses applied to skin for 20 minutes four to six times daily can aid in drying out the oozing lesions. 

Mastocytomas and diffuse cutaneous mastocytosis are further manifestations of cutaneous mastocytosis (CM) [9]. Solitary mastocytomas are common in children. Most are present at birth or develop in infancy. These lesions are flat or mildly elevated, well demarcated, solitary yellowish red-brown plaques or nodules, typically 2-5 cm in diameter. Diffuse cutaneous mastocytosis is a rare disorder characterized by diffuse mast cell infiltration of large areas of the skin that presents in infants in the first year of life. Severe edema and leathery indurations of the skin leads to accentuation of skin folds (pseudo-lichenified skin) and a peau-dbrange-like appearance. Systemic complications include hypotension and gastrointestinal hemorrhage. Infants and young children with considerable mast cell infiltration of the skin sometimes exhibit blister formation in the first 3 years of life. MPCM and other forms of CM have been classified in a consensus nomenclature (table 1) [10]. 

Topical corticosteroids may be used for short-term treatment of acute flare-ups (see Table 16-1 in Chap. 16 on Psoriasis). Most corticosteroids are applied once or twice daily. High-potency agents are used for less than 3 weeks for flare-ups or for lichenified (thickened) lesions. Moderate-potency steroids may be used for more chronic conditions, and low-... 

In chronic lichenified atopic dermatitis skin lesions, fewer IL-4 and IL-13 mRNA-expressing cells are present, but greater numbers of IL-5, GM-CSF, IL-12, and IFN-y mRNA-expressing cells are detected. The rise in IL-5 expression during the transition from acute to chronic atopic dermatitis likely plays a role in the prolongation of eosinophil survival and function. Some of the other cytokines mentioned above support the function of macrophages and promote the Th-1-type... 

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