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Atopic Dermatitis 101

Introduction

Learning Objectives
  • Evaluate and apply recent advances in the pathogenesis of atopic dermatitis (AD) to effective management of AD in children
  • Effectively identify signs and symptoms of AD in children using patient interview and visual examination of the skin
  • Develop skin-directed, patient-specific treatment plans for children with AD in order to reduce the frequency and severity of AD flares and decrease reliance on pharmacologic interventions
  • Counsel and provide support for children with AD and their families in order to improve quality of life

Epidemiology and clinical characteristics:

Atopic dermatitis (AD), also commonly referred to as eczema, is a chronic relapsing inflammatory skin disorder that primarily affects children.  Its prevalence has been rising and recently published data from the 2003 National Survey of Children’s Health indicated a prevalence of about 10% in most U.S. states (Shaw et al.).

Figure 1 - map (http://www NULL.stanford NULL.edu/group/smblogs/cgi-bin/cme/ad_101/wp-content/uploads/2011/05/map_intro NULL.jpg)

 

Children with AD will usually present early in life with 60% having onset by age 1 and 85% with onset by age 5. Essential features are that of a chronic, relapsing eczematous dermatitis with characteristic areas of involvement and significant pruritus. The areas of involvement vary according to age:

Figure 2 - Infants (http://www NULL.stanford NULL.edu/group/smblogs/cgi-bin/cme/ad_101/wp-content/uploads/2011/05/baby_011 NULL.gif)

Infants: Cheeks, trunk, groin, and extremity involvement

Figure 3 - Children (http://www NULL.stanford NULL.edu/group/smblogs/cgi-bin/cme/ad_101/wp-content/uploads/2011/05/child_011 NULL.gif)

Children: Flexural areas involved in childhood

Figure 4 - Adults (http://www NULL.stanford NULL.edu/group/smblogs/cgi-bin/cme/ad_101/wp-content/uploads/2011/05/adult_011 NULL.gif)

Adults: Hands and feet predominantly affected

Features that support a diagnosis of AD are early age of onset, personal or family history of atopy, ichthyosis vulgaris, and xerosis. However, it must be stressed that the diagnosis of AD is primarily clinical.

The importance of understanding AD:

Recent studies have presented the concept of the “atopic march” which suggests that patients with atopic dermatitis can go on to develop food allergy, allergic rhinitis, and asthma (Spergel).  Studies suggest that effective treatment of atopic dermatitis may prevent or delay the other components of the “atopic march.”  Optimal management of atopic dermatitis is increasingly important.

The number of office visits for pediatric patients with AD is steadily increasing (Horii et al.).  Eighty percent of these children are cared for by their primary care providers (PCPs).  Studies suggest that many pediatric training programs lack sufficient dermatology training and that primary care providers tend to undertreat AD (Henderson et al, Resnick et al).  PCPs will likely continue to bear the burden of treating children with mild to moderate atopic dermatitis due to workforce shortages of pediatric dermatologists and other pediatric subspecialists (Stern and Nelson).  Mild to moderate AD can be effectively managed by adequately-trained PCPs.