Treating pediatric atopic dermatitis

Atopic dermatitis (AD) presents through itchy, rough, dry skin, with symptoms increasing and decreasing in intensity. Symptoms usually begin to appear in patients aged under 2 years and is more common in patients with a strong family history of AD, or those with allergies or asthma.

In infants, AD symptoms will often present on the face, scalp, trunk, back, elbows, and knees. In children, they will often present on the neck, popliteal fossa, ankles, and feet.

AD can be treated through daily bathing, moisture, sensitive products, and topical medications. Moisture can be obtained through bland ointment or cream emollient. Sensitive products for treating AD should be dye-free and scent-free soap, laundry detergent, and dryer sheets. Topical medications for treating AD include topical corticosteroid and topical calcineurin inhibitor.

Wet wraps may also be used for treating AD. Bandages should be layered with cotton clothing and gauze to provide cooling, anti-inflammatory, and anti-itch outcomes. This method increases hydration, decreases trans-epidermal water loss, and leads to vasoconstriction. Barriers include time and tolerability.

When using wet wraps, ointment or cream is applied, followed by a double layer consisting of a wet inner layer and dry out layer. Maintenance should occur when medication is not used, and acute care of flares should occur when medication is used.

Bleach baths are another method of AD treatment, having displayed a 22% improvement of AD. There is a high chance of benefit and low risk of harm using this method, decreasing symptom severity and potentially decreasing S. aureus colonization. This suggests anti-inflammatory action. However, they are poorly understood, leading to calls for further research.

Proactive therapy, which is recommended by the European Atopic Dermatitis Treatment Guidelines, has also proven effective against AD. It has shown significant improvements in lesions, AD flares, and quality of life.

Dupilumab (Dupixent; Sanofi and Regeneron) is another effective method of treating AD. It is applied through a syringe or pen injection every 2 or 4 weeks depending on patient weight. Outcomes include decreased inflammation and improved skin barrier defects, making it effective for moderate to severe AD in children aged 6 months and older.

Reference

Flynn R. Atopic dermatitis: treatment strategies and a patient experience with dupilumab therapy. Presented at: 44th National Conference on Pediatric Health Care. March 15-19, Orlando, Florida.