'Dennie Morgan' folds are seen in?

Ans. D. Atopic dermatitis (Ref. IADVL 2nd/433, 416-427; Rook's 7th/18.1 - 18.30)Dennie Morgan fold is a single or double fold in the lower eyelid, may be due to eyelid edema caused by eyelid dermatitis. It is seen as associated feature in atopic dermatitis.Atopic dermatitis# Is an eczema characterized by intense itching and relapsing course in infants and children with a personal or family h/o atopic disorders.# Coexists with asthma or rhinitis in 80% cases.# 70% of patients have family h/o atopy.# Genetically transmitted# Immunological dysfunction and 80% have raised total IgE.# Itching is the basic symptom.1Infantile phase# Upto 2 yrs.# Appears usually at or after 3 months of age.# Initial lesions are illdefined erythematous patches on the cheeks.# Later spread to scalp, upper trunk and extensor aspect of lower limbs.2Childhood phase# Flexural involvement is characteristic (antecubital and popliteal fossa)# Presence of extensor involvement denotes poor prognosis.3Adolescent phase# Lichenification is main feature# Involvement of face, neck, flexures and upper trunk is characteristic.# Excoriation due to scratching are important manifestation.Perioral pallor, pallor at nose and ears (Head light sign) and dermographism are characteristic of atopic dermatitis.Associated features:# Xerosis,# Ichthyosis# P.alba,# Dennie-Morgan fold0# Periorbital darkening# Cataract# Keratoconus# Lipstick cheilitis# Hand and foot eczema Management:1 First line therapy# Emollients# Topical steroids# Topical antiinfectives# Antihistaminics2 Second line therapy# Systemic steroids# Immunomodulators (azathioprine, cyclosporine, interferons, tacrolimus)# PhototherapyAdditional Educational points:Iris or target lesions= Erythema multiformieBulla spread sign and Nikolsky's sign= Pemphigus vulgaris.Auspitz sign= Plaque Psoriasis.Darrier's sign= Urticaria pigmentosa.White dermographism= Atopic dermatitis.Dimple sign= Dermatofibroma.