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Atopic dermatitis (AD) is a chronic inflammatory skin and multisystem disease that affects children differently in different age categories.
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Consideration for the presence of comorbidities is important in caring for the pediatric AD patient.
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Infantile AD can be complicated by overlap with irritant contact dermatitis and seborrheic dermatitis.
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School-aged children with AD often suffer intercurrent infections with viral and bacterial pathogens.
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Teenagers with AD may have impaired body images and are
Special Considerations for Therapy of Pediatric Atopic Dermatitis
Section snippets
Key points
Clinical Nuances
This brief overview includes common features noted in infancy that impact diagnosis and therapeutic considerations. The clinical nuances overlap with comorbidities, but are reviewed in only 1 section in the interest of space.
AD is defined as a pruritic eczematous condition with a chronic, relapsing course and a typical pattern of appearance, in infancy and early childhood of “facial, neck and extensor involvement,” and often accompanied by early age of onset, xerosis, and other forms of atopy.11
Clinical Nuances
AD clinical manifestations varies with age. Although dermatitis involving the face, trunk, and/or extensor extremities predominates in infants, flexural surfaces like the wrists/ankles and antecubital/popliteal fossae are more common in toddlers and preschool- and school-aged children. It may also present with other features.40 The knowledge of the prevalence of less common clinical manifestations of AD according to age in different populations might be helpful in diagnosing incipient cases of
Pityriasis alba
Pityriasis alba is a common, idiopathic asymptomatic condition. Pityriasis alba is associated with AD as a minor diagnostic criterion. Pityriasis alba is most often present in school-aged children with no gender bias.46 Poorly circumscribed, hypopigmented patches are most often on the face and proximal upper extremities. Patches become more prominent during summer sun exposure as the surrounding skin tans, and it is more apparent on darker skin tones.46 In winter, hypopigmentation is less
Clinical Nuances
Although traditional dogma taught that most pediatric AD clears over time, in fact, active pediatric AD may continue to flare or worsen in adolescence. Factors associated with adolescent flaring are yet to be fully determined; however, it is known that adolescent (>10 years) severity on the Nottingham Eczema Severity Score is associated with eczema onset in infancy, dust mite and food allergen sensitization, dietary avoidance, use of wet wrap, traditional Chinese medicine, immunomodulants
Summary
AD is a complex multisystem disorder with its greatest manifestation in the skin. Therapy varies by age and developmental stage of childhood, and nuances in care should be addressed to allow for maximal disease control throughout childhood and adolescent years.
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Cited by (23)
Topical Therapies
2022, Atopic Dermatitis: Inside Out or Outside InComparison of Phototherapy in Pediatric and Adult Patients
2020, Actas Dermo-SifiliograficasNew and emerging therapies for paediatric atopic dermatitis
2019, The Lancet Child and Adolescent HealthCitation Excerpt :Sedating antihistamines might negatively affect long-term sleep patterns and school performance. Systemic immunosuppressive agents and corticosteroids are associated with poor short-term and long-term adverse event profiles, including infection and malignancy.24 Thus, long-term physical and psychosocial development of children and adolescents might be negatively affected by both uncontrolled atopic dermatitis and its treatments.
Pathophysiology and Management of Mild to Moderate Pediatric Atopic Dermatitis
2018, Journal of Pediatric Health CareCitation Excerpt :The clinical features of AD are often indistinguishable from other dermatologic conditions that can mimic, overlap, or complicate AD. The most common differential diagnoses to consider are contact dermatitis, psoriasis, scabies, and seborrheic dermatitis (Silverberg & Durán-McKinster, 2017). Research from the past decade has gleaned evidence of genetic, environmental, and immunologic factors that contribute to the pathogenesis of AD (Figure 1).
Skin diseases associated with atopic dermatitis
2018, Clinics in DermatologyCitation Excerpt :Sun avoidance and use of sunscreen can help prevent accentuation of the hypopigmented lesions. Emollients may be used to minimize scaling but will not aid in repigmentation.21 Agents that have been documented as efficacious in the treatment of PA include tacrolimus, pimecrolimus, and calcitriol.25, 29, 30
Disclosure: Dr N. Silverberg has relevant disclosure of consulting and or investigative work for Anacor/Pfizer and Astellas.