Open Access
Feature Article

Common skin problems in children. Managing atopic dermatitis

Open Access
Feature Article

Common skin problems in children. Managing atopic dermatitis

Gayle Fischer

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© GRANATA68/SHUTTERSTOCK.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© GRANATA68/SHUTTERSTOCK.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
Professor Fischer is Professor of Dermatology at Sydney Medical School – Northern, the University of Sydney, Royal North Shore Hospital, Sydney, NSW.

Abstract

Atopic dermatitis is the most prevalent chronic skin disease seen in children, particularly before puberty. Accurate, family-focused advice from the GP is key to treatment success and maintaining remission.

Key Points

  • Atopic dermatitis (AD) is common and the range of severity large, ranging from trivial to life ruining.
  • Diagnostic criteria for AD have been established.
  • About 50% of patients with AD have an abnormality of filaggrin, an epidermal protein involved in the protective skin barrier.
  • Itch, which results in sleep deprivation, can disrupt the lives of children with AD and significantly affect their families.
  • Environmental modification is an essential part of management; however, house dust mite reduction measures are only effective among a subgroup of patients and are controversial.
  • Topical therapy with emollients that restore the skin barrier is key.
  • Topical corticosteroids are gold standard therapy.
  • Corticosteroid phobia continues to be a significant barrier to effective treatment.
  • Allergy testing is often requested by parents, but it does not change management in most cases and is probably carried out more than is necessary.
  • When a child fails to respond to treatment, consider noncompliance, infection, allergy or combination with another dermatosis, most often psoriasis.
  • The prognosis for AD is good, with most children recovering by the end of primary school.

Worldwide, atopic dermatitis (AD) is the most common condition seen in paediatric dermatology practice. The prevalence of atopy in the Australian population is about 20% and most patients with the condition are children.

AD is a genetic condition with complex genetic susceptibility moderated by environmental factors. Most affected children have a first-degree family member with an atopic condition, not necessarily dermatitis, and about 40% have a deficiency of the epidermal protein filaggrin, which is involved in the normal skin barrier. Additionally, atopic immune dysregulation related to the T-helper 2 (Th2) cytokine cluster can occur. Children with severe AD commonly have raised total immunoglobulin (Ig) E levels.

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Various scoring methods are used to determine severity of AD, for instance the Eczema Area and Severity Index (EASI). These are most useful in a research setting. Assessing severity in a clinical setting can be done pragmatically, not only by noting the extent and clinical severity but also by assessing the impact on quality of life of the child, burden of treatment on the family and degree to which sleep is disturbed.

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