PEDIATRIC HEALTH
Manifestation and Management of Atopic Dermatitis in the Pediatric Population By Faraz Yousefian, DO and Liliana Espinoza, BS
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topic dermatitis (AD), or eczema, is one of the most common dermatological conditions physicians encounter in the pediatric population. The standard of care for these dermatological conditions can provide both physical and psychosocial relief to the patients and their caregivers. For this reason, it is of paramount importance to understand its causes, symptoms and best treatment options available to mitigate its effects. AD is an allergic spectrum disorder that affects 20% of children with a prevalence of 60% in the first year of life and 90% in the first five years of life.1-3 Additionally, approximately 60% of AD cases persist into adulthood, with 15% of patients later developing
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a food allergy, allergic rhinitis and/or asthma.1-3 The majority of AD patients have a family history of AD, as the risk of developing AD can increase 2-5-fold if both parents have AD.1,3 The pathophysiology of this disease is characterized by a decreased expression of the structural protein filaggrin, a decrease in ceramide lipid, increased protease expression, and immunologic abnormalities related to interleukin 4 and 13, which in conjunction affect the integrity of the skin barrier.3 Namely, these abnormalities lead to increased skin pH, decreased hydration, decreased S. aureus resistance, increased susceptibility to allergens and disorders of keratinization.1,3
SAN ANTONIO MEDICINE • September 2021
The Hanifin-Rajka (H-R) criteria is considered the gold standard diagnostic criteria for AD; however, it is not utilized by all allergists or dermatologists.2,4,5 AD is commonly diagnosed based on history and physical presentation; however, immunodeficiency conditions such as Hyper-IgE syndrome and Omenn syndrome should be ruled out initially.3 The cutaneous findings resulting from AD are commonly located on the face, scalp and flexor body surfaces.1,3,5 AD manifestations include dry skin accompanied with severe pruritis; erythematous maculo-papular rashes; vesicles that can have exudate and crusting (acute flare); dry, scaly excoriated patches (more chronic lesions);
