OVERVIEW OF ATOPIC DERMATITIS IN PEDIATRICS.pptx

Overview of Atopic Dermatitis in Pediatric Population

1. ATOPIC DERMATITIS P resenter: DR. ORUJ F acilitator: dr. mariam This Photo by Unknown Author is licensed under CC BY-NC-ND

2. CASE SCENARIO Baby A : 8 months old . c/c: R ash on cheeks and hands for 3 months a/w Sleep disturb ance . Family history of allergic rhinitis in mother. Tried Vitamin E cream inconsistently; no improvement. Growth otherwise normal. DDX?

3. INTRODUCTION 1 Chronic, pruritic, inflammatory skin disease. Commonly affects both children and adults.  Associated with an elevated serum level of IgE and a personal or family history of atopy.

4. ATOPIC TRIAD

5. EPIDEMIOLOGY 1 AD affects approximately 5 to over 20 percent of children worldwide. Countries in Africa, Oceania, and the Asia-Pacific region have higher rates of AD than countries in the Indian subcontinent and Northern/Eastern Europe. AD has an onset before the age of five years , and prevalence data in children show a slight female preponderance.

6. TANZANIAN DATA? In Tanzania: limited national data . U rban school surveys show AD ~2-3% of children, though overall skin-disease burden is high.

7. RISK & PROTECTIVE FACTORS 2

8. PATHOPHYSIOLOGY 1 Multiple mechanisms in pathogenesis of AD contributed by genetic and or environmental factors. Epidermal barrier dysfunction. Immune dysregulation (Th2 cell) Hypothesis: ”Outside-In” hypothesis. “Inside-Out” hypoothesis.

9. EPIDERMAL BARRIER 1 Epidermal barrier function = Stratum Corneum : First line of defense  → pathogens, allergens. Maintains water homeostasis. Prevents  transepidermal water loss (TEWL).

10. EPIDERMAL BARRIER DYSFUNCTION 1

11. FILAGGRIN DEFICIENCY 3

12. IMMUNE DYSREGULATION & INFLAMMATION 1

13. PATHOGENESIS OF AD

14. CLINICAL FEATURES 1 Variable presentation, depening on: Age, Ethnicity and Disease activity. Cardinal features: Dry skin. Pruritis (severe). In children, AD occurs in the first year of life in 60% cases and by the age of 5 years in nearly 85% cases.

15. DISTRIBUTION 1

16. LESION CHARACTERISTIC 1

17. ACUTE V/S CHRONIC

18. DARK SKIN 1

19. ATOPIC STIGMATA 1 Centrofacial pallor White dermographism Keratosis pilaris Palmar hyperlinearity Pityriasis alba Periorbital darkening ("allergic shiners") and Dennie -Morgan infraorbital folds Thinning or absence of the lateral portion of the eyebrows ( Hertoghe's sign) Infra-auricular and retroauricular fissuring Nipple eczema

20. CLINICAL VARIANTS Regional variants: Atopic hand eczema. Eyelid eczema. Atopic cheilitis. Morphological variants: Nummular dermatitis. Prurigo nodularis type. Follicular type.

21. SEVERITY ASSESSMENT 4

22. DIAGNOSIS 1 Clinical. F eatures: pruritus + typical morphology/distribution + chronic/relapsing course ± personal/family atopy. Investigations reserved for specific indications. Consider culture if secondary infection suspected.

23. DDX 1 Seborrheic dermatitis Contact dermatitis (irritant or allergic) Scabies Impetigo / secondary bacterial infection Psoriasis (rare in infants) Nutritional/rare metabolic dermatoses

24. MANAGEMENT PRINCIPLES 1 ,4 Education + eczema action plan for caregivers. Restore barrier: regular emollient therapy. Control inflammation: topical anti-inflammatories for flares. Treat infection promptly. Step-wise escalation: from basic care → topicals → phototherapy/systemic/biologics.

25. SKIN CARE & EMOLLIENTS 1 ,4 Apply emollients liberally at least twice daily and immediately after bathing (soak-and-seal within 3 minutes). Prefer cream or ointment formulations, especially thicker ointments for dry skin. Bathing: lukewarm water, short duration, gentle non-soap cleansers; pat dry, apply emollient. Avoid known triggers: fragranced soaps, wool clothing, overheating/sweating.

26. TOPICAL THERAPY 1 ,4 Topical corticosteroids (TCS): mainstay for flares; use lowest effective potency by site (e.g., hydrocortisone 1% for face; low/moderate potency for body). Topical calcineurin inhibitors (TCI): steroid-sparing option for face/folds; useful for maintenance.

27. INFECTION MANAGEMENT 1 ,4 Suspect infection with increased pain, weeping, honey-coloured crusts, pustules, or systemic signs. Localized impetigo → topical mupirocin . Widespread infection or systemic features → oral antistaphylococcal antibiotics.

28. ANTIHISTAMINE ? 1 ,4 Non-sedating antihistamines have limited benefit for AD itch. Short-term sedating antihistamines may help nighttime sleep in some infants/children. Emphasize sleep hygiene and environmental measures.

29. REFERENCES Silverberg JI, Howe W, Dellavalle RP, Levy ML, Fowler J, Hussain Z, Corona R. Atopic dermatitis (eczema): Pathogenesis, clinical manifestations, and diagnosis and Management . In: UpToDate,  Hülpüsch , Claudia & Weins , Andreas & Traidl -Hoffmann, Claudia & Reiger , Matthias. (2021). A new era of atopic eczema research: Advances and highlights. Allergy. 76. 10.1111/all.15058. Irvine AD, McLean WHI, Leung DYM. Filaggrin mutations associated with skin and allergic diseases. N Engl J Med. 2011;365(14):1315–1327. doi:10.1056/ NEJMra1011040 . Eichenfield , Lawrence F. et al. Guidelines of care for the management of atopic dermatitis. Journal of the American Academy of Dermatology, 2014. Volume 70, Issue 2, 338 - 351