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Pediatric Atopic Dermatitis

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Summary

Atopic dermatitis is a severe form of eczema that causes scaly and itchy rashes. In most cases, it first appears in infants between the ages of 6 and 12 weeks. As many as 15 to 20 percent of children have atopic dermatitis but for some of them, symptoms will disappear by the time they reach early adulthood. 

Expanded Overview

Atopic dermatitis almost always begins in childhood, usually during infancy. It typically involves skin folds but may also include the cheeks, trunk, arms and legs. Many children with this condition have a personal or family history of seasonal allergies or asthma. Your child may complain of itching, which is followed by a red rash. His or her symptoms may be continuous or they may come and go. If your child scratches these patches, it can promote infection. Many children outgrow the condition or have milder cases as adults. For others, it is a chronic condition that requires more than one treatment.

Causes

The exact causes of atopic dermatitis aren't known, but it may be an autoimmune disorder triggered by a combination of environmental and genetic factors. Children with a parent who has atopic dermatitis are more likely to develop it, as are those with a parent who has hay fever or asthma.

Seasonal allergens, certain soaps and detergents, weather changes, stress and even food allergies can trigger or worsen an atopic dermatitis flare-up.

Symptoms

The types of symptoms of atopic dermatitis and their location often depend on the child's age. In children under two, skin lesions or rashes often appear on the face, scalp, hands and feet. In older children, skin changes usually show up inside the crook of the elbows and behind the knees. In a severe outbreak, rashes can appear anywhere on the body.

Symptoms of atopic dermatitis include:

  • Bumpy skin (especially on the thighs or on the back of the arms)
  • Discharge or bleeding from the ears
  • Dry skin over large areas of the body
  • Excessive itching (which may begin before a rash appears)
  • Leathery or thick skin (from long-term scratching)
  • Oozing, crusting blisters surrounded by redness or inflammation
  • Rashes
  • Raw patches of skin (from scratching)
  • Skin discoloration (mottled)

Tests and Diagnosis

To diagnose atopic dermatitis, your child’s doctor will conduct a physical examination and ask some general health questions. 

Treatment

Because atopic dermatitis is a chronic condition, it is important that your child stays away from triggers and avoids scratching affected areas of the skin.

Treatments may include:

  • Antihistamines to reduce itching
  • Antibiotic creams (for skin infections)
  • Immune-suppressing drugs including cyclosporine, methotrexate and mycophenolate mofetil
  • Keeping your child's fingernails cut short to prevent intense scratching
  • Limited use of systemic steroids
  • Lubricating your child's skin with ointments (petroleum jelly) or creams and lotions
  • Topical corticosteroid creams or moisturizers (prescribed by your child's doctor)
  • Phototherapy (a type of UV light therapy)
  • Using a humidifier to keep the air moist

Things to avoid include:

  • Chemicals and solvents
  • Exposure to water for long periods of time (give your child shorter, cooler baths)
  • Foods that may cause allergic reactions
  • Irritants such as cigarette smoke or pollution
  • Sudden changes in temperature
  • Stress
  • Scrubbing or drying the skin
  • Soaps or detergents that include alcohol, scents or dyes
  • Wool or synthetic clothing

FAQs

How common is atopic dermatitis?

Atopic dermatitis is very common, affecting between 15 and 20 percent of infants and children. Around 18 million people in the U.S. have the condition.

What are the causes of atopic dermatitis in children?

Doctors don’t know what causes atopic dermatitis. It is believed to be an autoimmune disorder related to heredity and environmental factors.

What are the symptoms of atopic dermatitis in kids?

Symptoms of atopic dermatitis usually include large painful rashes or blisters, often located behind the knees and inside the crook of the arms. Symptoms often decrease as children age, sometimes disappearing completely by adulthood.

How is atopic dermatitis diagnosed in children?

Because atopic dermatitis has symptoms similar to other conditions, it is difficult to diagnose. Your child’s doctor will ask you for a medical history and perform physical tests on your child to be sure.

What are the treatments for atopic dermatitis in children?

Treatments for atopic dermatitis range from avoiding triggers, to using medications such as corticosteroid creams. Children should avoid scratching affected areas and stay away from harsh chemicals and scented soaps.

Can I prevent my child from getting atopic dermatitis?

Studies show that children who are breastfed before they are 4-months old are less likely to get the disease. If formulas must be used, choose one that includes processed cow milk protein (partially hydrolyzed).

Resources

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