seborrheic dermatitis, and contact dermatitis may occur in isolation, they may also coexist in a patient with atopic dermatitis The typical distribution can vary by age Infants have lesions on the cheeks, trunk, and extensor surfaces Children show involvement of the hands, feet, and flexor areas, such as the antecubital and popliteal fossae, and the neck ( Fig 65.1 ) In adolescents and adults, flexor areas, hands, and feet are often involved Xerosis (dry skin), ichthyosis vulgaris (inherited fish-like scaling of the extremities and hyperlinear palms), keratosis pilaris (follicularly based papules with cornified plugs in the upper hair follicles), infraorbital eyelid folds (Dennie–Morgan sign), pityriasis alba (scaly hypopigmented macules and patches on the cheeks), and follicular accentuation may be seen The main factors to assess when caring for patients with atopic dermatitis include pruritus, superinfection, and concomitant contact dermatitis The pruritus of atopic dermatitis may be severe, resulting in sleep disturbances in the child and caretakers and difficulty concentrating in school and work The persistent itch-scratch cycle can also lead to severe excoriations in the skin This damage to the skin barrier, along with inherent defects in the skin barrier and immunity that are associated with atopic dermatitis, makes patients particularly susceptible to superinfections with bacteria (Staphylococcus aureus or group A streptococcus), yeast (candida), and viral infections (herpes simplex, enterovirus, and molluscum contagiosum) The defective skin barrier in atopic dermatitis allows increased penetration of contact allergens that is felt to explain the increased incidence of contact dermatitis in this population (see below) Management of atopic dermatitis includes minimizing triggers (irritants and allergens) with “gentle skin care,” including an unscented soap, fragrance-free laundry detergent, hypoallergenic shampoo and conditioner, and regular application of thick unscented emollients immediately after bathing Repeated screening for new trigger contactants is important because care providers may try new topical products in an effort to provide relief Screening for infection is critical in all patients with atopic dermatitis flares, including culturing active pustules for bacteria and obtaining a viral culture or polymerase chain reaction (PCR) sample from vesicles or erosions for herpes simplex virus, and in some cases, enterovirus For