atopic%20dermatitis%20(pediatric)
ATOPIC DERMATITIS (PEDIATRIC)
Atopic dermatitis is a familial, chronic relapsing inflammatory skin disease characterized by intense itching, dry skin, with inflammation and exudation that commonly presents during early infancy and childhood, but can persist or start in adulthood.
It is also referred to as atopic eczema.
It is one of the most common skin diseases afflicting both adults and children.

Diagnosis

  • Diagnosis is based on patient history & physical exam
  • Investigate exacerbating factors
    • Eg Aeroallergens, foods, irritating chemicals, emotional stress
    • Not very useful clinically

Classification

Hanifin & Rajka Criteria for Diagnosis of Atopic Dermatitis

Major Criteria (must have ≥3)

  • Pruritus
  • Typical morphology & distribution
  • Facial & extensor involvement in infants & children
  • Dermatitis - chronically or chronically relapsing
  • Personal or family history of atopy - asthma, allergic rhinitis, atopic dermatitis

Minor Criteria (must have ≥3)

  • Facial features: facial pallor, facial erythema, hypopigmented patches, infraorbital darkening, infraorbital folds (Dennie-Morgan folds), cheilitis, recurrent conjunctivitis, anterior neck folds
  • Triggers: foods, emotional factors, environmental factors, skin irritants
  • Complications: susceptibility to cutaneous infections, impaired cell-mediated immunity, immediate skin-test reactivity, elevated IgE, keratoconus, anterior subcapsular cataracts
  • Others: early age of onset, dry skin, ichthyosis, hyperlinear palms, keratosis pilaris, hand & foot dermatitis, nipple eczema, white dermatographism, perifollicular accentuation

United Kingdom Working Party Diagnostic Criteria for Atopic Dermatitis

  • Itchy skin condition plus ≥3 of the following:
    • Visible flexural dermatitis w/ involvement of skin creases or on the cheeks & extensor surfaces for infants <18 months old
    • Flexural involvement (eg antecubital & popliteal fossa) or on the cheeks & extensor surfaces for infants <18 months old
    • History of dry skin within the last 12 months
    • Personal history of asthma or allergic rhinitis, or atopic dermatitis in a 1st degree relative if <4 years old
    • Signs & symptoms started when <2 years of age in patients ≥4 years old

Evaluation

Disease Severity

  • A holistic approach may be applied when assessing severity of disease
  • Severity Skin Quality of Life & Social Wellbeing
    Mild W/ areas of dry skin, infrequent pruritus w/ or w/o areas of redness Minimal impact on quality of life (some disturbance during the day & during sleep, mild changes in psychosocial wellbeing)
    Moderate W/ areas of dry skin, frequent pruritus, redness w/ or w/o excoriation & skin thickening Moderately affects quality of life including everyday activities & psychosocial wellbeing, sleep frequently disrupted
    Severe Extensive areas (>20%) of dry skin, intensely pruritic, erythema w/ or w/o excoriation & skin thickening; often complicated by persistent infections Significant disruption of quality of life; sleepless nights; lost school days
  • Ocular or infectious complications may also be present in severe atopic dermatitis
  • May require hospitalization for severe eczema or skin infections
  • Severity may also be assessed using different scoring methods (eg SCORing Atopic Dermatitis [SCORAD], Eczema Area & Severity Index [EASI], Patient Oriented Eczema Measure [POEM])
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