A teenager with atopic dermatitis Name: Oliver Age: 16 years History: Oliver has had dermatitis for most of his life. He has required medication from the time that his skin condition was first diagnosed when he was a baby. At the age of 9, Oliver developed asthma, which his mother also has. Oliver's asthma has increased in severity to the point that he has been hospitalised twice with bad asthma attacks. He has never attended hospital with his dermatitis but he is very self- conscious about it since it occurs on his face, the side of his neck, his wrists and ankles, and the flexures of his elbows and knees. It is very visible, especially during a flare-up, and he is particularly embarrassed when he goes swimming with his friends. Adolescents are often extremely self-conscious, even without a condition such as dermatitis, and they also have a strong need to be accepted by their peer group. Adolescence is a period of sexual and emotional exploration that lays the foundations for adult behaviour. Since dermatitis (and some of the treaments that may be used for it) affects physical appearance, physical and emotional performance, and sexual attractiveness, it can have profound long-term consequences. Oliver is interested in cars and would like to be a mechanic when he leaves school. The school careers advisor points out that the oil and grease is likely to exacerbate his dermatitis or to cause irritant contact dermatitis (which anyone who has had atopic dermatitis is more susceptible to). He suggests that Oliver should think about an alternative career. Diagnosis: Oliver goes to his doctor for advice. He diagnosed Oliver as having atopic dermatitis many years ago, and Oliver is now consulting him for a discussion about his prognosis. Management: Oliver has been managing his dermatitis with the occasional use of topical steroids and with regular use of emollients, for many years. But the doctor discovers that, now that Oliver is old enough to take over control of his treatment from his mother, he is not using the topical steroids appropriately. His mother had been told to reserve their use for flare-ups and to only apply them to the face and neck when Oliver had a particularly severe rash. However, Oliver tends to use them liberally on his face whenever he thinks that a rash is developing. This is because he is desperate to prevent any severity of rash from developing on his face. The doctor spends some time re-educating Oliver on the use of topical steroids. He explains that topical steroids may thin the skin on Oliver's face and cause cosmetic problems that may never go away. He cautions him not to use them so much. But he can offer no solution to Oliver's social problems, beyond the recommendation for counselling with a psychologist if Oliver feels really unhappy. Prognosis: Oliver's doctor tells him that his condition will probably continue to improve, but that he may still have atopic dermatitis in adult life. He has predisposing factors for this (family history of atopy and personal history of asthma). He is also, like our other patients, at greater risk of getting irritant contact dermatitis than people who have not had atopic dermatitis.