Management of atopic dermatitis

The treatment of atopic dermatitis is symptomatic and adapted to the disease activity. Dermocorticoids (for acute phases) et emollients (mostly away from acute phases) are the most important drug classes. Other treatments will also be addressed in this review.     

Severe atopic dermatitis in children

Atopic dermatitis has a strong impact on the quality of life of the child, and on the family : it is here that its severity is. The severe clinical forms of the disease must be detected, followed up and should benefit from the new therapeutic tools, without losing the very individual dimensions of disease acceptance, treatment observance and treatment response. The medical speech must be harmonized for the patient, the ideal being the multi-disciplinary approach which is complementary and finally synergistic.     

Contact sensitization in children with atopic dermatitis

Background

Atopic dermatitis is a common illness in childhood. Children with atopic dermatitis are prone to develop cutaneous sensitization due to skin barrier dysfunction.

Management of cryptorchidism in children: guidelines

QUESTION: To develop clinical guidelines for the management of cryptorchidism in pre-pubertal boys, from early diagnosis through therapy to long-term follow-up and prognosis. METHOD: Systematic review of articles from the medical literature, referenced since 1966, using validated search strategies through the following databases: Medline, Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, EMBASE, DARE, ACP Journal Club, National Guidelines Clearinghouse, Guidelines International Network. Relevant articles published after 1988 were taken as the basis for the statements. Each statement was graded on the basis of the study design and on its methodological quality (GRADE approach). A multidisciplinary panel of local experts discussed and evaluated each statement on the strength of this evidence. RESULTS: 28 statements based on the best available evidence were drafted. The experts agreed with all but two statements, which were rated uncertain. CONCLUSIONS: Cryptorchidism is best diagnosed clinically, and treated by surgical orchiopexy at age 6-12 months, without a routine biopsy. If no testis is palpable, or if other signs of hypovirilisation such as hypospadias are present, the chromosomal sex and hormonal status must be assessed. Laparoscopy is the best way of diagnosing and managing intra-abdominal testes.     

Dissecting the causes of atopic dermatitis in children: less foods, more mites

Atopic dermatitis (AD) is a common, chronic or chronically relapsing, multifactorial skin disease that mainly occurs in children but affects also adults. AD usually begins early in life and often concerns people with a personal or family history of asthma and allergic rhinitis. AD is characterized by eczematous changes in the epidermis and originates from a late, T-cell mediated reaction associated to the formation and production of memory T-cell of TH2 type, occurrence of homing receptor at skin level and cutaneous lymphocyte-associated (CLA) antigens. Extrinsic or allergic AD, but not intrinsic AD, shows high total serum IgE levels and the presence of specific IgE for environmental and food allergens. A pivotal role in the pathogenesis of AD is played by filaggrin, a protein contained in the granular layer of the epidermis regulating the aggregation of keratin filaments. Mutation in the filaggrin gene causes decreased barrier function of the corny layers of the epidermis. This favours the enter through the skin of environmental allergens, especially the house dust mite, that further facilitates such entering by the proteolytic activity of its major allergen Der p 1. In fact, recent advances suggest that the dust mite, more than foods, is the major cause of allergic AD. As far as the causal diagnosis of AD is concerned, there is notable evidence supporting the capacity of the atopy patch test (APT) to reproduce the pathophysiologic events of AD. This makes APT a valuable diagnostic tool for AD.     

Assessment of IgE-mediated food allergies in children with atopic dermatitis

BackgroundAtopic dermatitis (AD) is an inflammatory disease of the skin, which is characterised by a chronic relapsing course.AimThe aim of the study was to assign the prevalence of clinically active food allergies among a group of children between 3 months and 7 years of age, with AD.MethodsEighty-eight children with AD were screened for specific IgE antibodies to food proteins. All patients with AD and specific IgE antibodies to food proteins were subjected to Oral Food Challenges (OFCs) with the relevant foods.ResultsFood-sensitised patients with moderate levels of sIgE had clinically active food allergy to milk (39.28%) and egg (42.34%) on the basis of positive OFCs. High IgE and eosinophilia had a prevalence of almost 80% and 25%, regardless of concomitant food sensitisation and disease severity.ConclusionsIn this study, clinically active food allergies were recognised in 26.13% of children with AD. Nevertheless, no association was confirmed between food sensitisation and AD severity. High IgE and peripheral eosinophilia have not been found more prevalent among children with severe AD nor among children with food sensitisation. Infants and younger children with AD should be screened for an underlying food allergy, regardless of disease severity.     

Sleep-related disorders in Latin-American children with atopic dermatitis: A case control study

BackgroundAtopic dermatitis (AD) has been associated with impairment of sleep. The aim of this study was to evaluate sleep disorders in AD Latin-American children (4–10 years) from nine countries, and in normal controls (C).MethodsParents from 454 C and 340 AD children from referral clinics answered the Children Sleep Habits Questionnaire (CSHQ), a one-week retrospective 33 questions survey under seven items (bedtime resistance, sleep duration, sleep anxiety, night awakening, parasomnias, sleep-disordered breathing and daytime sleepiness). Total CSHQ score and items were analysed in both C and AD groups. Spearman's correlation coefficient between SCORAD (Scoring atopic dermatitis), all subscales and total CSHQ were also obtained.ResultsC and AD groups were similar regarding age, however, significantly higher values for total CSHQ (62.2 ± 16.1 vs 53.3 ± 12.7, respectively) and items were observed among AD children in comparison to C, and they were higher among those with moderate (54.8%) or severe (4.3%) AD. Except for sleep duration (r = −0.02, p = 0.698), there was a significant Spearman's correlation index for bedtime resistance (0.24, p < 0.0001), sleep anxiety (0.29, p < 0.0001), night awakening (0.36, p < 0.0001), parasomnias (0.54, p < 0.0001), sleep-disordered breathing (0.42, p < 0.0001), daytime sleepiness (0.26, p < 0.0001) and total CSHQ (0.46, p < 0.0001). AD patients had significantly higher elevated body mass index.ConclusionLatin-American children with AD have sleep disorders despite treatment, and those with moderate to severe forms had marked changes in CSHQ.     

Gene polymorphisms of 22 cytokines in macedonian children with atopic dermatitis

Atopic dermatitis (AD) is a common chronically relapsing skin disease associated with abnormal cytokine production, and activation of T-helper 2 cells. The aim if this study was to determine whether cytokine gene polymorphisms might influence the development of AD. Single nucleotide polymorphisms in the genes for I-L1alpha, IL-1beta, IL-1R, IL-2, IL-4, IL-6, IL-10, IL-12, TGF beta, TNF and IFNgamma were investigated by PCR and sequence specific primers in Macedonian patients with AD (67 children, age of 6 months to 5 years) and 301 normal unrelated individuals. Susceptible cytokine polymorphisms for AD for eleven genotypes (IL-4 -33/T:T IL-4 -1098/G:G, TGFbeta cdn25C:G, IL-4 -1098/T:T, IL-1alpha -889/C:T, IL-2 +166/T:T, IL-1beta -511/C:T, IL-12 -1188/C:T, IL-10 -1082/A:G, IL-1beta +3962/C:T, IFNgamma +874/A:T), five diplotypes, six haplotypes, and for alleles were found. Protective cytokine polymorphisms for AD for seven cytokine genotypes (IL-4 -1098/G:T, TGFbeta cdn25/G:G, IL-4 -33/C:C, IL-1alpha -889/C:C, IFNgamma +874/A:A, IL-10 -1082/A:A, IL-1beta -511/C:C), one cytokine diplotypes, two cytokine haplotypes, and four cytokine alleles were also found. We concluded that several cytokine polymorphisms are protective, or susceptible associated with AD in population of Macedonians.     

Factors determining parenting stress in mothers of children with atopic dermatitis

Background

Atopic dermatitis (AD) influences a child's emotional and social well-being, as well as his or her physical health. The influence of AD on the daily lives of parents and caregivers has also been documented. This study examined how parenting stress is affected by demographic background, characteristics of children's AD, and their family systems.

Neurodevelopment at 6 years of age in children with atopic dermatitis

BackgroundFew studies have reported an association between atopic dermatitis and cognitive impairment in children. Therefore, we evaluated the association between atopic dermatitis (AD) and neurodevelopmental dysfunction in children.MethodsWe analyzed 2,395,966 children born between 2008 and 2012 in Korea. All data were acquired from the databases of the Korean National Health Insurance System. AD was defined as five or more diagnoses before age 24 months. The outcome was suspected neurodevelopmental dysfunction in the gross motor skill, fine motor skill, cognition, language, sociality, and self-care domains of the Korean Developmental Screening Test for Infants and Children at age 6 years. The positive control outcome was defined as attention deficit hyperactive disorder (ADHD). The associations were assessed using ordinal logistic regression, adjusting for asthma and allergic rhinitis.ResultsAmong the eligible children, 89,452 and 30,557 were allocated to the control and AD groups, respectively. In the weighted data, the AD group showed a higher risk of suspected neurodevelopmental dysfunction in the total score (weighted adjusted odds ratio [95% CI] 1.10 [1.05–1.16]), gross motor skills (1.14 [1.04–1.25]), and fine motor skills (1.15 [1.06–1.25]) than the control group. The AD with steroids or hospitalization groups showed an increased risk of suspected neurodevelopmental dysfunction. In addition, the AD group showed a significant association with mental retardation, psychological development disorder, and behavioral and emotional disorders as well as ADHD.ConclusionsAD before age 2 years may be associated with an increased risk of neurodevelopmental dysfunction including gross and fine motor skills in the young childhood period.     

Sweat in the pathogenesis of atopic dermatitis

Sweat is a transparent hypotonic body fluid made from eccrine sweat glands. Various ingredients contained in sweat are involved in a broad sense in skin homeostasis including temperature regulation, skin moisture, and immune functions. Thus, sweat plays a major role in maintaining skin homeostasis. Therefore, abnormal sweating easily compromises human health. For example, in atopic dermatitis (AD), perspiration stagnation accompanying sweat tube or sweat pore blockage, leakage of perspiration from the sweat gland to the outside tissue, and impaired secretion of sweat from the sweat gland are confirmed. In recent years, the hypothesis that atopic dermatitis is a sweat stasis syndrome has been clarified by the establishment of a sweat and sweat gland dynamic analysis technique. Secretion of sweat and leakage into tissues is caused by dermatitis and is thought to promote itching. Furthermore, from the metabolomic analysis of sweat of patients with atopic dermatitis, it was confirmed that the glucose concentration in AD sweat increased according to severity and skin phenotype, suggesting that elevated glucose affected the homeostasis of the skin. Multifaceted analyses of sweat from subjects with AD have revealed new aspects of the pathology, and appropriate measures to treat sweat can be expected to contribute to long-term control of AD.     

Change in prevalence of atopic dermatitis between 1986 and 2001 among children

The prevalence of atopic dermatitis (AD) has increased during the last decades. Whether the prevalence is still increasing or has reached a stable level during the 1990s is still not certain. The purpose of this study was to compare the prevalence of AD in two different random samples of Danish children studied in 1986 and 2001 and to examine the associations between AD and other atopic outcomes. Two samples of children and adolescents living in urban Copenhagen were drawn at random from the civil registration list in 1986 and 2001. A total of 527 and 480 subjects participated in 1986 and 2001, respectively. Subjects were classified as AD cases when responding affirmatively to the question "Do you have, or have you ever had, significant and recurrent episodes of eczema in the folds of your elbows or knees?" Immunoglobulin E (IgE) measurements, skin-prick tests, and airway responsiveness tests were performed. The prevalence of AD increased from 17.3% in 1986 to 27.3% in 2001. For male subjects, the prevalence of AD was 16.4% in 1986 compared with 25.7% in 2001. For female subjects, the prevalence of AD was 18.1% in 1986 compared with 28.7% in 2001. Elevated levels of IgE, airway hyperresponsiveness (AHR), and rhinitis were statistically significant predictors of AD. The prevalence of AD has increased significantly from 1986 to 2001 in urban Copenhagen, Denmark. In addition, we found that AD was significantly associated with AHR, rhinitis, and elevated levels of IgE, supporting the idea of the atopic triad.     

Sensitization in early age to food allergens in children with atopic dermatitis

BackgroundClinical and laboratory evidence increasingly supports the notion that food allergy plays a role in the pathogenesis of atopic dermatitis (AD). However, the prevalence of clinically significant food hypersensitivity among children with AD remains an unanswered question.ObjectiveTo prospectively determine the prevalence of IgE-mediated food hypersensitivity among patients referred to a dermatology department for evaluation of AD, and to analyze the clinical relevance of these sensitizations in AD.MethodsWe studied 44 infants of both sexes, aged less than 12 months old, who attended the dermatology department with symptoms of AD. Compliance with Hanifin-Rajka criteria was confirmed and the severity of AD was evaluated using the SCORAD index. IgE-mediated sensitization to cow's milk, alpha-lactalbumin, beta-lactoglobulin, casein, eggwhite, egg-albumin, ovomucoid and foods introduced into the diet was studied using the skin prick test (SPT) and measurement of specific serum IgE (sIgE) by CAP System fluorescein-enzyme immunoassay.Cow's milk, as well as suspected foods from the clinical history or those with a positive SPT and/or sIgE, were withdrawn from the diet to evaluate improvement in AD, and an open controlled challenge test was carried out.ResultsOf the 44 patients studied, sensitization to foods was detected in 27 (61%). No changes were observed in AD during the elimination diet or when the eliminated foods were subsequently reintroduced into the diet. The results of open controlled food challenges were positive in 12 patients (27 %).ConclusionsA high prevalence of food sensitization was found in infants with AD. The most frequent sensitization observed was to egg, although with little clinical relevance since this food had not been introduced into the diet.In the sample studied, the clinical relevance of the observed food hypersensitivities was confirmed in relation to AD. Further studies are required to confirm these results.