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.

Atopic%20dermatitis%20(pediatric) Diagnosis

Diagnosis

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

Classification

Hanifin and Rajka Criteria for Diagnosis of Atopic Dermatitis

Major Criteria (must have ≥3)

  • Pruritus
  • Typical morphology and distribution
  • Facial and extensor involvement in infants and 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 and 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 with involvement of skin creases or on the cheeks and extensor surfaces for infants <18 months old
    • Flexural involvement (eg antecubital and popliteal fossa) or on the cheeks and 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 and 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 and Social Wellbeing
    Mild With areas of dry skin, infrequent pruritus with or without areas of redness Minimal impact on quality of life (some disturbance during the day and during sleep, mild changes in psychosocial wellbeing)
    Moderate With areas of dry skin, frequent pruritus, redness with or without excoriation and skin thickening Moderately affects quality of life including everyday activities and psychosocial wellbeing, sleep frequently disrupted
    Severe Extensive areas (>20%) of dry skin, intensely pruritic, erythema with or without excoriation and 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 and Severity Index [EASI], Patient Oriented Eczema Measure [POEM])
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