Ayu Rizky Andhiny

MANAGEMENT OF ATOPIC DERMATITIS:

ARE THERE DIFFERENCES
BETWEEN CHILDREN AND ADULTS?
ABSTRACT
Atopic dermatitis (AD) usually begins during
infancy
Classical form infantile AD the scalp, the face
and the extensor surfaces of the extremities.
It may present as erythroderma
In the management we have to consider the
high ratio of body surface to body weight
Especially in early childhood off-label use is a
common practice.
ATOPIC DERMATITIS
Atopic dermatitis (AD) most common chronic disease in infancy
Affects up to every 5th child in western populations.
Usually begins during the rst year of life 50% will persist into
adulthood.
The differences between children and adults with AD :
1. The face-to-face contact/interview with two different persons
(parents and children)
2. Skin physiology (barrier function, immune system)
3. Clinical aspects (morphology, distribution, differential diagnoses)
4. Atopic march (atopic symptoms are in development)
5. Management (trigger factors, off-label use medication, topical
dermatotherapy)
THE FACE-TO-FACE CONTACT/INTERVIEW WITH TWO
DIFFERENT PERSONS (PARENTS AND CHILDREN)
The dialogue between the patient and the
doctor the basis of bond of trust &
determines the adherence to treatment.
In adulthood, the patient is directly the
person of contact
In childhood the doctor deals mainly with the
parents.
Some studies focussing on parents and
patients education effective form of
management.
Study of Cork et al., (education regarding the
cause of AD and the right use of drugs and
emollients)led to a signicant reduction in
the severity of AD and an increased use of
emollients improving patients and families
quality of life.
SKIN PHYSIOLOGY AND PATHOPHYSIOLOGY IN EARLY
CHILDHOOD
The skin of infants <2 years is characterized by :
1. Thinner epidermis and stratum corneum,
smaller corneocytes
2. Low levels of natural moisturizing factors
(NMFs) and surface lipid concentrations
3. High pH, high desquamation and also high
proliferation rates.
These ndings result in impaired epidermal
barrier structure and function which is
vulnerable to environmental factors and to
topically applied drugs and emollients.
CLINICAL ASPECTS (MORPHOLOGY, DISTRIBUTION,
DIFFERENTIAL DIAGNOSES)
Early childhood, pruritus, the hallmark of AD, is
difcult to recognize.
The differences compared with older children
and adults regard the predilection sites and the
morphology.
PredilectionThe head and the face (rstly)
affected followed by the extensor of the
extremities.
The morphology very exudative lesions,
erythema, papules, pustules, crusts and oozing.

ATOPIC MARCH (ATOPIC SYMPTOMS ARE IN
DEVELOPMENT)
Study with 259 adult AD patients, 18 patients (6.9%)
were assigned as intrinsic AD (normal IgE levels and
lack of sensitizations towards environmental
allergens)during the time of follow-uppatients had
developed respiratory allergies and/or IgE mediated
sensitizations (extrinsic AD)
In accordance with the atopic march the prevalence
rates of intrinsic AD in infantsthe natural
history of atopic manifestations characterized by
onset of AD in early childhood and followed by
asthma and allergic rhinitiswe have to consider in
clinical practice that AD in children may reappear
after years of remission
MANAGEMENT (TRIGGER FACTORS, OFF-LABEL
USE-MEDICATION, TOPICAL DERMATOTHERAPY)
Trigger factors Food allergy is more
common in children than in adults (cows milk
and eggs)
food allergy in early childhood is often of
transient natureallergological tests should
be performed after 12 years later to re-
evaluate the clinical

Off-label-use-medicationa different dose
and frequency of the drug than normally
indicated, different disease indications, age
groups which are out of the licensed for use
and different routes of administration
prednisolone (most common off-label
drug)used in children with severe AD
Systemic immunosuppressive drugs are
used in refractory AD in children
Topical dermatotherapy : have a high risk of
absorption, mainly in early childhood due to
the high ratio of body surface to body weight
should be aware of the possibility of side-
effects applying topical inammatory drugs
(corticosteroids and calcineurin inhibitors)
not necessary to apply twice daily, once daily
is sufcient

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