infantile phase - usually presents between 3 and 6 months. The cheeks, wrists and hands tend to be affected but the rash may occur anywhere; generally, the nappy area is spared. Extensors often become involved as the baby starts to crawl. The lesions tend to be red, scaly and scratched. Secondary infection and lymphadenopathy are common. Many resolve within 18 months; others progress to the flexural pattern of the childhood phase.
childhood phase - lichenification becomes predominant. Thickened excoriated skin, with prominent skin markings, commonly affects the elbow and knee flexures, the wrists and ankles, the dorsa of the feet under the straps of shoes, and the retroauricular fold. Occasionally, discoid patches of eczema present on the limbs. Persistence of the extensor pattern with marked lichenification may be seen in Afro-caribbean, Asian and Chinese children.
adolescent and adult phase - striking lichenification is seen in the popliteal and antecubital fossae, and on the nape of the neck. Spread may occur to the upper chest, back and arms. There are often prominent infraorbital creases, creating a weary and prematurely aged expression. Continual rubbing may result in thinning of the lateral half of the eyebrows - Hertoghe's sign.
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