Atlas of Pediatric Cutaneous Biodiversity by Nanette B. Silverberg & Nanette B. Silverberg

Author:Nanette B. Silverberg & Nanette B. Silverberg
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Atopic Dermatitis (“Eczema”)

Atopic dermatitis is the most common skin condition seen in a pediatric dermatology clinic in developed nations, with symptomatology especially common in the 2–5 year age range. Atopic dermatitis is defined as a relapsing or chronic pruritic skin disorders, primarily of early onset, with typical distribution in infancy on the face and extensors, in childhood on the flexural areas and over the hands and feet in adults. Seventy percent of children will have a family history of atopy and many of the children themselves will have comorbid atopy (e.g., asthma, allergic rhinitis and/or conjunctivitis, atopic dermatitis), especially when a parent has asthma. Food allergies should be suspected in children with history of food-induced flares, extensive disease with poor response to therapy, and in children with family history of food allergy.

Allergen patterns should be kept in mind based on the child’s ethnicity. While milk, egg, and soy are the leading allergens in most studies worldwide; Middle Eastern children have early sesame exposures and are more at risk for such allergies [1]. Asian children are exposed to shellfish and peanuts early on (6–12 months) and rates of allergy are 39% and 27%, respectively, in children tested [2]. When suspected, avoidance of oral and topical food allergens is essential.

Atopic dermatitis affects children of all races and ethnicities; however, differences exist in the incidence of atopic dermatitis by race and ethnicity, in the clinical features, in the response to therapies (both prescription and over-the-counter) and in the associated stigmata and general health problems that arise in association with atopic dermatitis.

Children who are Black are 1.7 times more likely to have atopic dermatitis than Caucasian children in the United States. Asian and Black children are more likely to have medical visits for atopic dermatitis than Caucasian children [3]. Almost 75% of atopic dermatitis cases seen in a pediatric dermatology clinic in Miami were Black children [4]. The east coast of the United States has the highest prevalence of cases, exceeding 11.5% in most states of the region [5]. The prevalence of atopic dermatitis in the Hispanic population of South America appears to be 11.3%; however, data on the incidence of minor criteria in Hispanic children is lacking and is therefore not included in Table 8.1 [23]. Filaggrin mutations are highly associated with atopic dermatitis in all ethnicities and races, with palmar hyperlinearity and keratosis pilaris being noted especially in Asian children with filaggrin mutations [11].Table 8.1Atopic dermatitis diagnostic criteria and presence of the criteria by race or ethnicitya

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