Paediatric Atopic Dermatitis

Patient Information: Understanding Paediatric Atopic Dermatitis

What is Paediatric Atopic Dermatitis?

Paediatric atopic dermatitis, commonly known as eczema, is a chronic inflammatory skin condition that often begins in infancy or early childhood. It is characterised by red, itchy, and dry patches of skin that can appear anywhere on the body, but commonly affect the face, neck, elbows, and knees.

Causes and Exacerbating Factors:

1. Genetics: Family history plays a significant role in the development of atopic dermatitis. Children with a family history of eczema, asthma, or allergies are at higher risk.
2. Environmental Triggers: Exposure to certain environmental factors, such as harsh soaps, detergents, wool clothing, or extreme temperatures, can trigger or exacerbate eczema symptoms.
3. Skin Barrier Dysfunction: Children with atopic dermatitis often have a compromised skin barrier, making their skin more susceptible to irritants and allergens.
4. Allergens: Allergens such as dust mites, pet dander, pollen, and certain foods can trigger eczema flare-ups in some children.
5. Infection: Secondary infection (bacterial or viral) can worsen and flare eczema.

Prognosis:

While paediatric atopic dermatitis can be a chronic condition, many children experience improvement as they get older. With proper management and treatment, the severity and frequency of flare-ups can be minimised, allowing children to lead normal, healthy lives.

Importance of Treatment:

Effective treatment of atopic dermatitis is essential to relieve symptoms, prevent complications, and improve your child’s quality of life. Untreated eczema can lead to complications such as skin infections, scarring, sleep disturbance and psychological distress.

Basic Instructions for Management:

1. Skin Care: Keep your child’s skin moisturised with emollients or moisturising creams to prevent dryness and itching. Use gentle, fragrance-free cleansers and avoid hot baths or showers, which can strip the skin of its natural oils.
2. Avoid Triggers: Identify and avoid triggers that can worsen eczema symptoms, such as harsh soaps, fragrances, wool clothing, and environmental allergens. Opt for hypoallergenic products and clothing whenever possible.
3. Topical Treatments: Your dermatologist may prescribe topical corticosteroids or calcineurin inhibitors to reduce inflammation and itching during flare-ups. Follow their instructions carefully for safe and effective use.
4. Manage Itching: Help your child manage itching by keeping their nails short, using cool compresses, and applying anti-itch creams or lotions as needed. Encourage them to avoid scratching to prevent further irritation and skin damage.
5. Regular Follow-up: Schedule regular follow-up appointments with your dermatologist to monitor your child’s condition, adjust treatment as needed, and address any concerns or questions you may have.

Treatment Options for Pediatric Atopic Dermatitis:

1. Emollients and Moisturizers:

• Emollients and moisturisers are essential for hydrating the skin and restoring the skin barrier function. They should be applied liberally and frequently, especially after bathing, to lock in moisture and prevent dryness.
• Choose fragrance-free, hypoallergenic moisturizers to minimize the risk of irritation.

1. Topical Corticosteroids:

• Topical corticosteroids are commonly used to reduce inflammation and itching during eczema flare-ups.
• They come in varying strengths, and your dermatologist will prescribe the appropriate potency based on the severity of your child’s symptoms and the location of the affected areas.
• Follow your dermatologist’s instructions regarding the frequency and duration.

1. Calcineurin Inhibitors:

• Calcineurin inhibitors, such as tacrolimus and pimecrolimus, are non-steroidal medications that can be used to treat eczema, particularly in sensitive areas like the face and neck.
• They work by suppressing the immune response and reducing inflammation.
• Like corticosteroids, they should be used under the guidance of a dermatologist.

1. Bathing and Hydration:

• Bathing plays a crucial role in managing eczema. Use lukewarm water and mild, fragrance-free cleansers to avoid drying out the skin.
• Limit bathing time to 5-10 minutes and pat the skin dry gently with a soft towel afterward.
• Apply moisturiser immediately after bathing to lock in moisture.

1. Wet Wrap Therapy:

• Wet wrap therapy involves applying a layer of moisturiser or topical medication to the affected areas, followed by a layer of wet bandages or clothing, and then a dry layer on top.
• This technique helps to hydrate the skin, reduce inflammation, and enhance the absorption of medications.
• It can be particularly beneficial during severe flare-ups or when other treatments have not provided sufficient relief.

1. Antihistamines:

• Antihistamines may be prescribed to help relieve itching and promote better sleep, especially if itching is interfering with your child’s rest.
• However, they are not typically used as first-line treatment for eczema and should be used with supervision.

1. Avoiding Triggers:

• Identify and avoid triggers that can exacerbate eczema symptoms, such as certain fabrics, harsh soaps, detergents, environmental allergens, and extreme temperatures.
• Keep a diary to track your child’s flare-ups and identify patterns or triggers that may be contributing to their eczema.

1. Allergen Avoidance:

• If your child has known allergies that trigger eczema flare-ups, take steps to minimise exposure to those allergens. This may involve using allergy-proof bedding, avoiding pets, or eliminating certain foods from their diet.

1. Phototherapy (Light Therapy):

• In some cases, phototherapy may be recommended for children with severe or widespread eczema that has not responded to other treatments.
• Phototherapy involves exposing the skin to ultraviolet (UV) light under medical supervision to reduce inflammation and itching.
• It is usually reserved for older children and adolescents

1. Biologic Therapies:
   • Biologic therapies are a newer treatment option for severe eczema that is not adequately controlled with other treatments.
   • These medications target specific molecules in the immune system that contribute to inflammation and itching.
   • Biologics are typically reserved for children with severe, refractory eczema and are administered by injection under the supervision of a dermatologist.

Conclusion:
Paediatric atopic dermatitis can be challenging to manage. There are various treatment options available to help manage pediatric atopic dermatitis and improve your child’s quality of life. It’s essential to work closely with your dermatologist to develop a comprehensive treatment plan tailored to your child’s needs and preferences. With proper care and ongoing management, most children with eczema can achieve significant relief from their symptoms and enjoy healthier, more comfortable skin.

If you have any questions or concerns about your child’s eczema or treatment plan, don’t hesitate to contact me.