Elsevier

Dermatologic Clinics

Volume 35, Issue 3, July 2017, Pages 351-363
Dermatologic Clinics

Special Considerations for Therapy of Pediatric Atopic Dermatitis

https://doi.org/10.1016/j.det.2017.02.008Get rights and content

Section snippets

Key points

  • Atopic dermatitis (AD) is a chronic inflammatory skin and multisystem disease that affects children differently in different age categories.

  • Consideration for the presence of comorbidities is important in caring for the pediatric AD patient.

  • Infantile AD can be complicated by overlap with irritant contact dermatitis and seborrheic dermatitis.

  • School-aged children with AD often suffer intercurrent infections with viral and bacterial pathogens.

  • Teenagers with AD may have impaired body images and are

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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References (95)

  • A.G. Ortega-Loayza et al.

    Characterization of Staphylococcus aureus cutaneous infections in a pediatric dermatology tertiary health care outpatient facility

    J Am Acad Dermatol

    (2010)
  • M.A. Dohil et al.

    The epidemiology of molluscum contagiosum in children

    J Am Acad Dermatol

    (2006)
  • N.B. Silverberg et al.

    Childhood molluscum contagiosum: experience with cantharidin therapy in 300 patients

    J Am Acad Dermatol

    (2000)
  • M. Tuchman et al.

    Nickel contact dermatitis in children

    Clin Dermatol

    (2015)
  • W. Larsen et al.

    Fragrance contact dermatitis: a worldwide multicenter investigation (Part I)

    Am J Contact Dermat

    (1996)
  • C.M. Cheng et al.

    Risk of developing major depressive disorder and anxiety disorders among adolescents and adults with atopic dermatitis: a nationwide longitudinal study

    J Affect Disord

    (2015)
  • M.A. Strom et al.

    Associations of physical activity and sedentary behavior with atopic disease in United States children

    J Pediatr

    (2016)
  • N.A. Slater et al.

    Systemic therapy of childhood atopic dermatitis

    Clin Dermatol

    (2015)
  • R. Sidbury et al.

    Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents

    J Am Acad Dermatol

    (2014)
  • E. Song et al.

    Phototherapy: kids are not just little people

    Clin Dermatol

    (2015)
  • D.L. Rodenbeck et al.

    Phototherapy for atopic dermatitis

    Clin Dermatol

    (2016)
  • H.R. Anderson et al.

    The natural history of asthma in childhood

    J Epidemiol Community Health

    (1986)
  • P.G. Burney et al.

    Has the prevalence of asthma increased in children? Evidence from the national study of health and growth 1973-86

    BMJ

    (1990)
  • H. Sugiura et al.

    Prevalence of childhood and adolescent atopic dermatitis in a Japanese population: comparison with the disease frequency examined 20 years ago

    Acta Derm Venereol

    (1998)
  • J.W. Yunginger et al.

    A community-based study of the epidemiology of asthma. Incidence rates, 1964-1983

    Am Rev Respir Dis

    (1992)
  • M.D. Klinnert et al.

    Onset and persistence of childhood asthma: predictors from infancy

    Pediatrics

    (2001)
  • P.E. Beattie et al.

    A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases

    Br J Dermatol

    (2006)
  • J.P. Kim et al.

    Persistence of atopic dermatitis (AD): a systematic review and meta-analysis

    J Am Acad Dermatol

    (2016)
  • D. Elish et al.

    Infantile seborrheic dermatitis

    Cutis

    (2006)
  • M.M. Kelleher et al.

    Skin barrier impairment at birth predicts food allergy at 2 years of age

    J Allergy Clin Immunol

    (2016)
  • R. Morris-Jones et al.

    Dermatitis caused by physical irritants

    Br J Dermatol

    (2002)
  • A. Alexopoulos et al.

    Retrospective analysis of the relationship between infantile seborrheic dermatitis and atopic dermatitis

    Pediatr Dermatol

    (2014)
  • S. Wananukul et al.

    Malassezia furfur in infantile seborrheic dermatitis

    Asian Pac J Allergy Immunol

    (2005)
  • F. Xu et al.

    Residential risk factors for atopic dermatitis in 3- to 6-year old children: a cross-sectional study in Shanghai, China

    Int J Environ Res Public Health

    (2016)
  • R. Kantor et al.

    Environmental risk factors and their role in the management of atopic dermatitis

    Expert Rev Clin Immunol

    (2017)
  • J.M. Hanifin et al.

    Diagnostic features of atopic dermatitis

    Acta Derm Venereol Suppl (Stockh)

    (1980)
  • J.M. Spergel et al.

    Food allergy in infants with atopic dermatitis: limitations of food-specific IgE measurements

    Pediatrics

    (2015)
  • S.H. Sicherer

    Early introduction of peanut to infants at high allergic risk can reduce peanut allergy at age 5 years

    Evid Based Med

    (2015)
  • D.M. Fleischer et al.

    Consensus communication on early peanut introduction and prevention of peanut allergy in high-risk infants

    Pediatr Dermatol

    (2016)
  • N.B. Silverberg

    Food, glorious food

    Cutis

    (2011)
  • H.A. Brough et al.

    Atopic dermatitis increases the effect of exposure to peanut antigen in dust on peanut sensitization and likely peanut allergy

    J Allergy Clin Immunol

    (2015)
  • L. Schneider et al.

    Study of the atopic march: development of atopic comorbidities

    Pediatr Dermatol

    (2016)
  • G.N. Stamatas et al.

    Infant skin physiology and development during the first years of life: a review of recent findings based on in vivo studies

    Int J Cosmet Sci

    (2011)
  • M.M. Tollefson et al.

    Atopic dermatitis: skin-directed management

    Pediatrics

    (2014)
  • M.B. Sauder et al.

    The effectiveness of written action plans in atopic dermatitis

    Pediatr Dermatol

    (2016)
  • Australasian Society of Clinical Immunology and Allergy (ASCIA). Action plan for eczema. Available at:...
  • American Academy of Dermatology (AAD). How will I know what to do to control the eczema? Available at:...
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      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).

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      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

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    Disclosure: Dr N. Silverberg has relevant disclosure of consulting and or investigative work for Anacor/Pfizer and Astellas.

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