ATOPIC DERMATITIS IN CHILDREN
Atopic dermatitis is a common skin disease in children.1-3 In some countries it can affect up to 20% of those under 18 years of age,1-3 while one study found that it affected children 2 to 6 times more than adults.3
Atopic dermatitis can have a huge impact on a child not just physically, but socially and psychologically as well.4,5 How do you know if your child is at risk or is showing symptoms? How is the condition managed and can it be cured? Read on and find out.
While Atopic dermatitis can run in families, genetics is not the only cause.
Atopic dermatitis has a genetic component, and most children who develop it will have someone in the family with the condition.1,2 A child with one parent who has atopic dermatitis is 2 to 3 times more likely to develop it.1 The risk is higher - around 3 to 5 times more likely - if both parents have it.1 And it’s not just atopic dermatitis, a family history of any allergic disease like asthma or hay fever also increases the risk.2
However, this does not mean that a child with no family history of allergies has zero risk.2 As many as 30% of children with atopic dermatitis don’t have any family members with an allergic condition.2
Atopic dermatitis can be caused by a combination of factors outside of genetics; including environmental factors (children in cities are more likely to develop it), the mother’s age (children of older mothers are at greater risk), problems with the immune system, and problems with the ability of the child’s skin to protect itself.1
That is why it’s important to know the symptoms. That way, if you think your child might have it, you can bring them to a doctor to get a diagnosis.
Symptoms in children are different from adults and may differ depending on the child’s age.
Atopic dermatitis is characterized by dry, scaling skin with intense itchiness.1,2,6 It starts with a rash, often with tiny bumps or fluid-filled blisters that can rupture and leak when scratched.2,6 Scratching causes the skin to become thickened or leathery, with hardened areas, which continue to feel itchy all of the time.1,6
In infants and toddlers, what’s usually affected are the face, elbows, or knees and exposed surfaces – places that are easily scratched or rubbed as they start crawling.2,6 The diaper area is often not affected, as the skin there is protected by higher moisture levels.2
In older children, thickened, itchy skin is more prominent in creases like the neck, insides of the elbows, wrists, knees and ankles.1,6 As the itchy patches are scratched, wounds develop, opening the door to secondary infections, which can further change the appearance of the skin.4-6 As they grow into adolescence and adulthood, the hands and feet become the areas primarily affected.7
Atopic dermatitis therefore has a range of different appearances.1-6 So even though what you are seeing does not look like the pictures you see online or other examples, it doesn’t mean that it’s not atopic dermatitis.1,2,5 It’s always best to consult a doctor to get proper evaluation and treatment.
Managing atopic dermatitis involves education, appropriate skin care and trigger avoidance.
Education is the key to successfully managing atopic dermatitis.4,6-8 This is a chronic skin disease that is the result of underlying immune mechanisms, so it’s important to understand that the goal is to minimize the impact of symptoms, avoid flare-ups, and maintain good skin care.4,6-8
Good skin care keeps the skin hydrated, which helps minimize symptoms and the impact of flares.4-9 With your doctor, plan a regular bath schedule, choose appropriate cleansers and moisturizers, and learn how to apply moisturizers properly.6-9 If your child is old enough, you can teach them to apply moisturizers themselves, but make sure to either supervise or check in periodically to make sure it’s being done right.4
Identify and avoid triggers with the help of your doctor.4-9 Do not try to identify triggers, especially food triggers, by yourself.4-9 Food triggers are actually not as common as you might think and removing certain foods from your child’s diet without confirming that it is indeed causing flares can lead to more health problems down the line.7
With your doctor’s guidance, prepare a flare management program.3,6 Also learn to gauge if it’s something that you can handle at home or if you need to go to the hospital for more intensive treatment.3,6
In certain cases of moderate to severe disease, your child might need prescription medication like higher-dose topical corticosteroids, or systemic therapies like immune-modulating drugs or biologics.4-9
Maintain continuous discussions with your doctor about the treatment regimen to avoid misunderstandings and using medication or skin care practices inappropriately.4,9 Atopic dermatitis management can be complicated, so be open to learning.4,9 If something is unclear, don’t be afraid to ask your doctor for clarification.4,9
There is no cure for atopic dermatitis, but things do get better.
Up to 75% of children with atopic dermatitis will show symptoms by 6 months, going up to 90% by the age of 5.6 The good news is that for most of these cases, symptoms will resolve, with less than 30% having regular episodes into adulthood.4
It’s important to get diagnosed and treated early as atopic dermatitis can have serious complications.4-7 Aside from a propensity for skin infections and long-term damage to the skin from scarring, the more concerning impact of atopic dermatitis might be the mental health implications for both the child and their immediate family.4-7
Education and appropriate intervention can minimize these effects, giving young patients living with atopic dermatitis the chance a brighter future.
- Atopicdermatitis.net. (2017). “Atopic Dermatitis in Children (2+ years old)”, https://atopicdermatitis.net/lifespan-children (Accessed October 20, 2021).
- National Eczema Association. “Atopic Dermatitis in Children”, https://nationaleczema.org/eczema/children/atopic-dermatitis/ (Accessed October 20, 2021).
- Silverberg, J.I., Barbarot, S., Gadkari, A., et al. (2021). Atopic dermatitis in the pediatric population: a cross-sectional international epidemiologic study. Ann Allergy Asthma Immunol, 126(4), 417-428. https://www.annallergy.org/article/S1081-1206(20)31275-8/fulltext
- Arkwright, P.D., Motala, C., Subramanian, H., et al. (2013). Management of difficult-to-treat atopic dermatitis. J Allergy Clin Immunol: In Practice, 1(2), 142-151. https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/Management-of-difficult-to-treat-AD-2013.pdf
- Lansang, P., Lara-Corrales, I., Bergman, J.N., et al. (2019). Approach to the assessment and management of pediatric patients with atopic dermatitis: a consensus document. Section IV: Consensus statements on the assessment and management of pediatric atopic dermatitis. J Cutan Med Surg, 23(5_suppl), 32S-39S. https://journals.sagepub.com/doi/10.1177/1203475419882654?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
- Raimer, S.S. (2000). Managing pediatric atopic dermatitis. Clin Pediatr (Phila), 39, 1-14. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.855.9756&rep=rep1&type=pdf
- Tollefson, M.M., Bruckner, A.L., et al. (2014). Atopic dermatitis: skin directed management. Pediatrics, 134(6), e1735-e1744. https://pediatrics.aappublications.org/content/134/6/e1735
- Page, S.S., Weston, S. & Loh, R. (2016). Atopic dermatitis in children. Aust Fam Physician, 45(5), 293-296. https://www.racgp.org.au/afp/2016/may/atopic-dermatitis-in-children/
- National Eczema Association. “Eczema Treatment for Children”, https://nationaleczema.org/eczema/children/treatment/ (Accessed October 20, 2021).
Health information contained herein is provided for general educational purposes only. Your healthcare professional is the single best source of information regarding your health. Please consult your healthcare professional if you have any questions about your health or treatment.