Atopic%20dermatitis%20(pediatric) Signs and Symptoms

• One of the most common skin diseases afflicting both adults and children
• Infant’s skin has a developing epidermal barrier and would only fully mature at least at 1st year of age thus their skin absorb more water and lose excess water faster than adult skin
  • This skin characteristic makes them susceptible to irritation and infections

• 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
• Also referred to as “atopic eczema”

• Common causes include allergens such as food, soaps, detergents, inhalant allergens and skin infections

• Heredity (80% in monozygous twins, 20% in heterozygous twins)
• Increased immunoglobulin E (IgE) production
• Lack of skin barrier producing dry skin due to abnormalities in lipid metabolism and protein formation
• Susceptibility to infections caused by Staphylococcus aureus/epidermidis and Malassezia furfur through abnormal microbial colonization
  • Decreased diversity of the cutaneous microbiome secondary to S aureus colonization is significantly associated with atopic dermatitis flare-up

Infants <2 years usually present with:

• Signs of inflammation usually develop during the 3rd month of life
• Patient commonly presents with red, scaling, dry areas
  • Usually found on the facial cheeks and/or chin
  • Lip licking may result in scaling, oozing and crusting on the lips and perioral skin, eventually leading to secondary infections
  • Perioral and perinasal sparing can be characteristic and patient may present with no lesions in these areas
• Continued scratching or washing will create scaling, oozing, red plaques on cheeks
  •  Infant may be restless or agitated during sleep
•  A small number of infants may present with generalized eruptions
  •  Papules, redness, scaling and lichenification
  •  Diaper area is usually not affected

Children 2-12 years usually present with:

• Inflammation in the flexural areas
  • Eg neck, wrists, ankles, antecubital fossae
• Rash may be contained to 1 or 2 areas
  •  May progress to involve more areas eg neck, antecubital and popliteal fossae, wrists and ankles
•  Papules that quickly change to plaques then lichenified when scratched
•  Constant scratching may lead to excoriations and eventual areas of hypo- or hyperpigmentation

Adolescents ≥12 years usually present with:

• Resurgence of inflammation that recurs near puberty
• Pattern of inflammation is the same as in a child 2-12 years
• Dry, scaling, erythematous papules and plaques