# A nurse is assessing a 6-year-old child with atopic dermatitis (eczema). Which assessment finding would be most characteristic of this condition? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542322 > language: ko > subject: Child Health ## 문제 A nurse is assessing a 6-year-old child with atopic dermatitis (eczema). Which assessment finding would be most characteristic of this condition? ## 보기 1. Honey-crusted lesions on the face and extremities 2. Silvery, scaly plaques on the knees and elbows 3. Vesicular lesions in a linear pattern 4. Dry, scaly, erythematous patches in flexural areas **✔ 정답** **정답: 4** ## 해설 Atopic dermatitis in children typically presents with dry, scaly, erythematous patches in flexural areas like antecubital and popliteal fossae. Other options describe conditions like impetigo (honey-crusted), psoriasis (silvery plaques), or contact dermatitis (linear vesicles). ## 심화 해설 Understanding the Question This question asks you to differentiate the characteristic skin lesion distribution of atopic dermatitis (eczema) in a school-age child from other common pediatric dermatological conditions. Recognizing the age-dependent pattern is key to selecting the correct answer. Analysis of Options To identify the correct finding, you must link the pathophysiology of atopic dermatitis to its clinical presentation and contrast it with the hallmark features of other skin disorders. - Option 1: Honey-crusted lesions on the face and extremities This description points to impetigo, a superficial bacterial skin infection, most often caused by Staphylococcus aureus or Streptococcus pyogenes. The characteristic honey-colored crusts form as the vesicular or pustular lesions rupture and dry. While children with atopic dermatitis are at increased risk for secondary bacterial infections like impetigo due to an impaired skin barrier, the honey-crusted lesion itself is not the primary, defining lesion of atopic dermatitis. [1] - Option 2: Silvery, scaly plaques on the knees and elbows This is the classic presentation of psoriasis. Psoriatic plaques are well-demarcated, erythematous, and covered with thick, silvery-white scales. They typically appear on extensor surfaces, such as the knees and elbows, and on the scalp. This distribution is the opposite of the typical flexural pattern seen in atopic dermatitis in older children. [1] - Option 3: Vesicular lesions in a linear pattern A linear pattern of vesicular lesions is a hallmark finding in contact dermatitis, particularly when caused by an external irritant or allergen like poison ivy. The linear arrangement reflects the path of direct contact with the offending agent on the skin. This pattern is not characteristic of the spontaneous, symmetric eczematous patches of atopic dermatitis. [1] - Option 4: Dry, scaly, erythematous patches in flexural areas This is the correct answer. Atopic dermatitis (AD) is a chronic, relapsing inflammatory dermatosis characterized by pruritus, xerosis, and age-dependent clinical heterogeneity. [1] In infants, the face and extensor surfaces are often involved. However, as a child grows, the distribution shifts. In a 6-year-old child, the most characteristic finding is the involvement of the flexural areas, specifically the antecubital and popliteal fossae. The lesions themselves are typically ill-defined, erythematous, dry, and scaly patches, reflecting the underlying xerosis and inflammation driven by a defective skin barrier, often linked to filaggrin loss-of-function variants. Clinical Reasoning and Pathophysiology The correct identification hinges on understanding the "age-dependent clinical heterogeneity" of atopic dermatitis. The underlying pathophysiology involves a complex interplay of genetic predisposition, epidermal barrier dysfunction, and immune dysregulation. A key component is a deficiency in filaggrin, a protein crucial for maintaining the skin's barrier function and hydration. Loss-of-function variants in the filaggrin gene lead to increased transepidermal water loss, resulting in the characteristic xerosis (dry skin), and allow for easier penetration of irritants and allergens, which triggers the inflammatory cascade. This chronic inflammation manifests as the erythematous, scaly patches. The predilection for flexural areas in older children is a well-recognized clinical phenotype, making it the most specific finding among the options for this age group. The intense pruritus that accompanies these lesions is a cardinal feature, often leading to a vicious itch-scratch cycle that further compromises the skin barrier.References (research sources) - [1]Atopic Dermatitis in Children: Differential Diagnosis and Mimickers.Research articleTüre Avcı B, Çetinarslan T, Türel Ermertcan A, Fölster-Holst R. (2026) · DOI: 10.3390/children13050690 ## 임상 시나리오 Atopic Dermatitis: Lesion DistributionAge-Specific Patterns Guide Assessment In infants, lesions typically appear on the face, scalp, and extensor surfaces of the extremities. In children aged 2 years to puberty, the characteristic distribution shifts to flexural areas, including the antecubital and popliteal fossae, neck, wrists, and ankles. CautionThe chronic, relapsing nature and intense pruritus are key diagnostic features. Always inspect for secondary bacterial infections like impetigo (honey-colored crusts) or viral infections like eczema herpeticum. ## 핵심 개념 - **Atopic Dermatitis** — A chronic, relapsing inflammatory skin condition associated with a defective skin barrier, commonly presenting with pruritus and age-specific lesion distribution. - **Flexural Distribution** — The pattern of skin lesions appearing in skin folds (antecubital and popliteal fossae, neck) typical of atopic dermatitis in children and adults. - **Impetigo** — A highly contagious superficial bacterial skin infection characterized by honey-colored crusts, often caused by Staphylococcus aureus. - **Psoriasis** — A chronic autoimmune skin disease characterized by well-demarcated, erythematous plaques with silvery scales, typically on extensor surfaces. ## 같은 주제 문제 - [A nurse is assessing a 12-year-old adolescent with atopic dermatitis (eczema). 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