1040 RESOLUTION OF EXFOLIATIVE DERMATITIS AND ALOPECIA AREATA OPHIASIS WITH THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA

Abstract

The comorbidity of atopic dermatitis and obstructive sleep apnea can have a reciprocal improvement with the use of continuous positive airway pressure. Patient is a 17 year old African American female with a history of severe exfoliative dermatitis exacerbations secondary to uncontrolled atopic dermatitis (AD) with eczema herpeticum who presented with dermatopathic lymphadenitis, alopecia areata ophiasis, night sweats, nocturia, habitual snoring with hypertrophy of the tonsils to the sleep medicine department for her snoring and nocturnal sweating. Night time sweats produced an intense pruritic response. Nocturia occurred four times a night. Autoimmune and infectious disease work ups were negative. Skin and lymph node biopsies revealed dermatopathic lymphadenitis secondary to exfoliative dermatitis. Treatments included avoidance of suspected AD triggers, emollients, hypo-allergenic soaps and topical steroids. The application of topical steroids resulted in exfoliative dermatitis with eczema herpeticum and staph infections multiple times. Gabapentin improved her pruritic condition and a slight improvement in her skin and scalp was noted. A sleep study revealed the patient to have an Apnea-Hypopnea index of 16.4, excessive sweating and severe snoring were also noted on her sleep study. The mother of the patient declined the use of immune modulating therapies including topical steroids, methotrexate, cyclosporine, and tacrolimus as well as the recommendation for a tonsillectomy. Patient and mother agreed to the use of CPAP and photographing the progression of the disease. No change in the patient’s medications nor consistency were noted. After 10 months of excellent CPAP compliance, photographical evidence as well as physical examination revealed the patient’s hair returned as well as her an improvement in her skin was noted. Nocturia resolved after the use of CPAP. Patient reported two weeks of not using her CPAP machine and reported a new onset of hair loss and worsening of eczema. The use of continuous positive airway pressure has the potential for reducing inflammatory responses in the skin for patients suffering from atopic dermatitis as well as obstructive sleep apnea, reducing the need for immune modulating therapies.