Atopic Dermatitis (AD) is a chronic inflammatory skin condition associated with a genetic predisposition to allergies, also known as atopic constitution. It presents as itching, eczematous skin lesions with a tendency to exude during acute phases. Some patients may also develop other allergic conditions like asthma, allergic rhinitis, and allergic conjunctivitis during the course of the disease.
Atopic Dermatitis is more common in children, with most cases occurring in infancy. Due to its tendency to recur, it can cause significant distress to both the affected children and their parents.
For infants and young children with AD, it is essential to choose suitable medication, take proactive care, and engage in preventive measures to alleviate and control clinical symptoms.
The development of pediatric atopic dermatitis is influenced by factors such as genetic predisposition, immune response, and skin barrier function.
AD is often caused by genetic mutations leading to abnormal expression of filaggrin (FLG), resulting in reduced skin barrier function, skin dryness, and increased susceptibility to environmental factors and antigenic substances. This, in turn, exacerbates skin lesions and is particularly problematic in children due to their less mature sebaceous glands, leading to dry skin(sources from therapeutique-dermatologique.org).
Atopic Dermatitis presents differently at different stages of life and is typically divided into infancy, childhood, and young adulthood.
Infancy: Most cases develop after two months of age. Initial skin lesions present as pruritic red patches on the cheeks, followed by pinpoint-sized papules and vesicles appearing on the erythematous base, often in clusters. Scratching and friction can lead to erosion, exudation, and crusting.
Childhood: AD in childhood often worsens 1-2 years after the initial outbreak in infancy. Skin lesions typically affect the flexural or extensor surfaces of the limbs, commonly found in elbow and knee creases. They are dark red, with mild exudation, and are often accompanied by scratch marks and lichenification.
Young Adulthood: This stage includes adolescents aged 12 and older and adults with AD. It often occurs on the flexor and extensor surfaces of the limbs, trunk, and body. Skin lesions often appear as localized lichenification, intense itching, scratch marks, blood crusts, scales, and pigmentation changes, among other secondary skin issues(quotes from therapeutique-dermatologique.org).
Pediatric Atopic Dermatitis: Essential Daily Care
Pediatric Atopic Dermatitis (AD) is a chronic and recurrent condition that requires long-term treatment. It’s essential to thoroughly analyze the causes and exacerbating factors to effectively avoid triggers, prevent relapses, reduce or alleviate complications, and enhance the child’s quality of life. This comprehensive approach includes three main aspects:
I. Basic Treatment
Bathing: Bathe the child once a day or every other day at a temperature between 32°C to 37°C for 5 to 10 minutes. This helps remove dirt and scales from the skin’s surface and reduces bacterial colonization.
Regular use of skincare products with ingredients that restore the skin barrier and have anti-inflammatory properties. Applying an adequate amount of moisturizing skincare products multiple times can prevent moisture loss, repair the damaged skin barrier, reduce sensitivity to external irritants, and decrease the frequency and severity of disease flare-ups. Avoid using moisturizers containing oat components as they may increase the risk of sensitization. Early use of moisturizers during infancy can help prevent and delay the onset of AD.
Environmental Improvements: Avoid scratching, friction, and physical irritations. Keep the skin free from sweat-related irritations. Maintain a humidity level between 18°C to 22°C. Ensure cleanliness and hygiene in the environment to reduce exposure to dust mites and animal dander.
Dietary Intervention: If clinical symptoms in children align with the results of allergen testing and indicate a food allergy, dietary avoidance may be recommended for 4 to 6 weeks. Parents can keep a daily food diary for their child. Blind dietary avoidance is not recommended(sources from therapeutique-dermatologique.org).
II. Topical Treatment
Use mild topical corticosteroids like hydrocortisone, desonide, and hydrocortisone butyrate, among others. Currently, a combination of moisturizers and topical corticosteroids is recommended to delay relapses and reduce their frequency. Topical calcineurin inhibitors like 1% pimecrolimus cream and 0.03% or 0.1% tacrolimus cream can be used on specific areas such as the face and skin folds.
III. Systemic Treatment
Antihistamines, such as loratadine syrup and levocetirizine oral solution, can be used to alleviate itching and discomfort in children. However, there are age restrictions on using these medications, so it’s essential to follow professional medical advice.
Over the past decade, the incidence of Atopic Dermatitis in China has been steadily increasing due to changes in lifestyle and the environment. It affects people of all age groups, particularly children. Currently, there is no definitive cure for AD, but with an understanding of proper treatment and care methods, parents can effectively manage and improve the condition, leading to symptom relief and remission.
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