Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section I: Overview of Pediatric Atopic Dermatitis
Restricted accessResearch articleFirst published online November, 2019
Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section I: Overview of Pediatric Atopic Dermatitis
Pediatric atopic dermatitis (AD) is one of the most common dermatoses encountered by health-care providers treating children. Diagnosis of AD is clinical, with no universally accepted biomarkers or assessment tools. Patient-reported outcomes and subjective assessments of quality of life in both the patient and family are important considerations when treating pediatric AD. Here, we provide an overview of pediatric AD epidemiology, its clinical presentation, burden, diagnosis, and assessment, with a focus on implications for patient counseling in order to optimize care.
PerkinMR.StrachanDP.WilliamsHC.KennedyCTC.GoldingJ. Natural history of atopic dermatitis and its relationship to serum total immunoglobulin E in a population-based birth cohort study. Pediatr Allergy Immunol. 2004;15(3):221-229.doi:10.1111/j.1399-3038.2004.00160.x
2.
KayJ.GawkrodgerDJ.MortimerMJ.JaronAG. The prevalence of childhood atopic eczema in a general population. J Am Acad Dermatol. 1994;30(1):35-39.doi:10.1016/S0190-9622(94)70004-4
3.
SpergelJM.PallerAS. Atopic dermatitis and the atopic march. J Allergy Clin Immunol. 2003;112(6 Suppl):S118-S127.doi:10.1016/j.jaci.2003.09.033
4.
EllisCN.ManciniAJ.PallerAS.SimpsonEL.EichenfieldLF. Understanding and managing atopic dermatitis in adult patients. Semin Cutan Med Surg. 2012;31(3 Suppl):S18-S22.doi:10.1016/j.sder.2012.07.006
5.
MortzCG.AndersenKE.DellgrenC.BaringtonT.Bindslev-JensenC. Atopic dermatitis from adolescence to adulthood in the TOACS cohort: prevalence, persistence and comorbidities. Allergy Eur J Allergy Clin Immunol. 2015;70(7):836-845.doi:10.1111/all.12619
6.
ParkKY.ParkMK.SeokJ.LiK.SeoSJ. Clinical characteristics of Korean patients with filaggrin-related atopic dermatitis. Clin Exp Dermatol. 2016;41(6):595-600.doi:10.1111/ced.12854
7.
IrvineAD.McLeanWHI.LeungDYM. Filaggrin mutations associated with skin and allergic diseases. N Engl J Med. 2011;365(14):1315-1327.doi:10.1056/NEJMra1011040
8.
SilverbergJI. Public health burden and epidemiology of atopic dermatitis. Dermatol Clin. 2017;35(3):283-289.doi:10.1016/j.det.2017.02.002
9.
AsherMI.MontefortS.BjörksténBet al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: Isaac phases one and three repeat multicountry cross-sectional surveys. Lancet. 2006;368(9537):733-743.doi:10.1016/S0140-6736(06)69283-0
10.
WilliamsHStewartAvon MutiusECooksonWAndersonHRInternational Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide?J Allergy Clin Immunol. 2008;121(4):947-954.doi:10.1016/j.jaci.2007.11.004
11.
WangHY.PizzichiniMMM.BeckerABet al. Disparate geographic prevalences of asthma, allergic rhinoconjunctivitis and atopic eczema among adolescents in five Canadian cities. Pediatr Allergy Immunol. 2010;21(5):867-877.doi:10.1111/j.1399-3038.2010.01064.x
12.
YewYW.ThyssenJP.SilverbergJI. A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. J Am Acad Dermatol. 2019;80(2):390-401.doi:10.1016/j.jaad.2018.09.035
13.
KimY.BlombergM.Rifas-ShimanSLet al. Racial/Ethnic differences in incidence and persistence of childhood atopic dermatitis. J Invest Dermatol. 2019;139(4):827-834.doi:10.1016/j.jid.2018.10.029
14.
AbuabaraK.YouY.MargolisDJ.HoffmannTJ.RischN.JorgensonE. Genetic ancestry does not explain increased atopic dermatitis susceptibility or worse disease control among African American subjects in 2 large US cohorts. J Allergy Clin Immunol. 2019.doi:10.1016/j.jaci.2019.06.044
15.
SánchezJ.SánchezA.CardonaR. Particular characteristics of atopic eczema in tropical environments. The tropical environment control for chronic eczema and molecular assessment (TECCEMA) cohort study. An Bras Dermatol. 2017;92(2):177-183.doi:10.1590/abd1806-4841.20175140
16.
AcevedoN.SánchezJ.ZakzukJet al. Particular characteristics of allergic symptoms in tropical environments: follow up to 24 months in the FRAAT birth cohort study. BMC Pulm Med. 2012;12(1):13.doi:10.1186/1471-2466-12-13
17.
AhmedA.HakimA.BeckerA. Evaluation of eczema, asthma, allergic rhinitis and allergies among the Grade-1 children of Iqaluit. Allergy Asthma Clin Immunol. 2018;14(1):9.doi:10.1186/s13223-018-0232-2
18.
AhmedA.BeckerA. Evaluation of eczema, asthma, allergic rhinitis and allergies among the grade-7 children of Iqaluit. Allergy Asthma Clin Immunol. 2019;15(1):26.doi:10.1186/s13223-019-0341-6
19.
ForseyRGP. Prevalence of childhood eczema and food sensitization in the First Nations Reserve of Natuashish, Labrador, Canada. BMC Pediatr. 2014;14(1):76.doi:10.1186/1471-2431-14-76
20.
Shreberk-HassidimR.HassidimA.GronovichY.DalalA.Molho-PessachV.ZlotogorskiA. Atopic dermatitis in Israeli adolescents from 1998 to 2013: trends in time and association with migraine. Pediatr Dermatol. 2017;34(3):247-252.doi:10.1111/pde.13084
21.
FarajzadehS.EsfandiarpourI.SedaghatmaneshM.SavizM. Epidemiology and clinical features of atopic dermatitis in Kerman, a desert area of Iran. Ann Dermatol. 2014;26(1):26-34.doi:10.5021/ad.2014.26.1.26
22.
SilverbergJI.HanifinJM.YorkN. Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. J Allergy Clin Immunol. 2013;132(5):1132-1138.doi:10.1016/j.jaci.2013.08.031
23.
UphoffE.CabiesesB.PinartM.ValdésM.AntóJM.WrightJ. A systematic review of socioeconomic position in relation to asthma and allergic diseases. Eur Respir J. 2015;46(2):364-374.doi:10.1183/09031936.00114514
24.
NodaS.Suárez-FariñasM.UngarBet al. The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization. J Allergy Clin Immunol. 2015;136(5):1254-1264.doi:10.1016/j.jaci.2015.08.015
25.
LeungDYM. Atopic dermatitis: age and race do matter!J Allergy Clin Immunol. 2015;136(5):1265-1267.doi:10.1016/j.jaci.2015.09.011
26.
HanifinJM.RajkaG. Diagnostic features of atopic dermatitis. Acta Derm Venereol. 1980;92(suppl):44-47.
27.
WilliamsHC.BurneyPG.PembrokeAC.HayRJ. The U.K. Working Party’s diagnostic criteria for atopic dermatitis. III. independent hospital validation. Br J Dermatol. 1994;131(3):406-416.doi:10.1111/j.1365-2133.1994.tb08532.x
28.
EichenfieldLF.HanifinJM.LugerTA.StevensSR.PrideHB. Consensus conference on pediatric atopic dermatitis. J Am Acad Dermatol. 2003;49(6):1088-1095.doi:10.1016/S0190-9622(03)02539-8
29.
EichenfieldLF.TomWL.ChamlinSLet al. Guidelines of care for the management of atopic dermatitis: section 1. diagnosis and assessment of atopic dermatitis work group. J Am Acad Dermatol. 2014;70(2):338-351.doi:10.1016/j.jaad.2013.10.010
30.
BrunnerPM.LeungDYM.Guttman-YasskyE.ImmunologicG-YE. Immunologic, microbial, and epithelial interactions in atopic dermatitis. Ann Allergy, Asthma Immunol. 2018;120(1):34-41.doi:10.1016/j.anai.2017.09.055
31.
WynnTA. Type 2 cytokines: mechanisms and therapeutic strategies. Nat Rev Immunol. 2015;15(5):271-282.doi:10.1038/nri3831
32.
NakatsujiT.GalloRL. The role of the skin microbiome in atopic dermatitis. Ann Allergy Asthma Immunol. 2019;122(3):263-269.doi:10.1016/j.anai.2018.12.003
33.
HonKL.TsangYC.PongNH.NgC.IpM.LeungTF. Clinical features and Staphylococcus aureus colonization/infection in childhood atopic dermatitis. J Dermatolog Treat. 2016;27(3):235-240.doi:10.3109/09546634.2015.1093586
34.
FilanovskyMG.PootongkamS.TamburroJE.SmithMC.GanocySJ.NedorostST. The financial and emotional impact of atopic dermatitis on children and their families. J Pediatr. 2016;169:284-290.doi:10.1016/j.jpeds.2015.10.077
35.
ReedB.BlaissMS. The burden of atopic dermatitis. Allergy Asthma Proc. 2018;39(6):406-410.doi:10.2500/aap.2018.39.4175
36.
BhanegaonkarA.QinL.HorodniceanuEH.JiX.DetzelP.BottemanM. Economic burden of pediatric atopic dermatitis in Asia-Pacific: a review of the literature. Value Heal. 2014;17(7):A778.doi:10.1016/j.jval.2014.08.358
37.
KwaL.SilverbergJI. Financial burden of emergency department visits for atopic dermatitis in the United States. J Am Acad Dermatol. 2018;79(3):443-447.doi:10.1016/j.jaad.2018.05.025
38.
ZuberbierT.OrlowSJ.PallerASet al. Patient perspectives on the management of atopic dermatitis. J Allergy Clin Immunol. 2006;118(1):226-232.doi:10.1016/j.jaci.2006.02.031
39.
BridgmanAC.EshtiaghiP.Cresswell-MelvilleA.RamienM.DruckerAM. The burden of moderate to severe atopic dermatitis in Canadian children: a cross-sectional survey. J Cutan Med Surg. 2018;22(4):443-444.doi:10.1177/1203475418761859
40.
AblettK.ThompsonAR.ParentalTAR. Parental, child, and adolescent experience of chronic skin conditions: a meta-ethnography and review of the qualitative literature. Body Image. 2016;19:175-185.doi:10.1016/j.bodyim.2016.10.001
41.
KongTS.HanTY.LeeJH.SonSJ. Correlation between severity of atopic dermatitis and sleep quality in children and adults. Ann Dermatol. 2016;28(3):321-326.doi:10.5021/ad.2016.28.3.321
42.
FishbeinAB.MuellerK.KruseLet al. Sleep disturbance in children with moderate/severe atopic dermatitis: a case-control study. J Am Acad Dermatol. 2018;78(2):336-341.doi:10.1016/j.jaad.2017.08.043
43.
PustišekN.Vurnek ŽivkovićM.ŠitumM. Quality of life in families with children with atopic dermatitis. Pediatr Dermatol. 2016;33(1):28-32.doi:10.1111/pde.12698
44.
BeattiePE.Lewis-JonesMS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol. 2006;155(1):145-151.doi:10.1111/j.1365-2133.2006.07185.x
45.
CamffermanD.KennedyJD.GoldM.MartinAJ.LushingtonK. Eczema and sleep and its relationship to daytime functioning in children. Sleep Med Rev. 2010;14(6):359-369.doi:10.1016/j.smrv.2010.01.004
46.
ChangY-S.ChouY-T.LeeJ-Het al. Atopic dermatitis, melatonin, and sleep disturbance. Pediatrics. 2014;134(2):e397-e405.doi:10.1542/peds.2014-0376
47.
ChangY-S.ChiangB-L. Sleep disorders and atopic dermatitis: a 2-way street?J Allergy Clin Immunol. 2018;142(4):1033-1040.doi:10.1016/j.jaci.2018.08.005
48.
ChamlinSL.MattsonCL.FriedenIJet al. The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis. Arch Pediatr Adolesc Med. 2005;159(8):745-750.doi:10.1001/archpedi.159.8.745
49.
MooreK.DavidTJ.MurrayCS.ChildF.ArkwrightPD. Effect of childhood eczema and asthma on parental sleep and well-being: a prospective comparative study. Br J Dermatol. 2006;154(3):514-518.doi:10.1111/j.1365-2133.2005.07082.x
50.
GooderhamMJ.BissonnetteR.GrewalP.LansangP.PappKA.HongCH. Approach to the assessment and management of adult patients with atopic dermatitis: a consensus document. section II: tools for assessing the severity of atopic dermatitis. J Cutan Med Surg. 2018.
51.
SchmittJ.SpulsPI.ThomasKSet al. The Harmonising outcome measures for eczema (HOME) statement to assess clinical signs of atopic eczema in trials. J Allergy Clin Immunol. 2014;134(4):800-807.doi:10.1016/j.jaci.2014.07.043
52.
ZhaoCY.TranAQT.Lazo-DizonJPet al. A pilot comparison study of four clinician-rated atopic dermatitis severity scales. Br J Dermatol. 2015;173(2):488-497.doi:10.1111/bjd.13846
53.
ZhaoCY.HaoEY.OhDDet al. A comparison study of clinician-rated atopic dermatitis outcome measures for intermediate- to dark-skinned patients. Br J Dermatol. 2017;176(4):985-992.doi:10.1111/bjd.15271
54.
ZhaoCY.WijayantiA.DoriaMCet al. The reliability and validity of outcome measures for atopic dermatitis in patients with pigmented skin: a grey area. Int J Women’s Dermatology. 2015;1(3):150-154.doi:10.1016/j.ijwd.2015.05.002
55.
ChopraR.SilverbergJI. Assessing the severity of atopic dermatitis in clinical trials and practice. Clin Dermatol. 2018;36(5):606-615.doi:10.1016/j.clindermatol.2018.05.012
56.
FutamuraM.LeshemYA.ThomasKS.NankervisH.WilliamsHC.SimpsonEL. A systematic review of investigator global assessment (IGA) in atopic dermatitis (AD) trials: many options, no standards. J Am Acad Dermatol. 2016;74(2):288-294.doi:10.1016/j.jaad.2015.09.062
57.
PatrickDL.BurkeLB.PowersJHet al. Patient-reported outcomes to support medical product labeling claims: FDA perspective. Value Heal. 2007;10(suppl 2):S125-S137.doi:10.1111/j.1524-4733.2007.00275.x
58.
BlackN.JenkinsonC. Measuring patients’ experiences and outcomes. BMJ. 2009;339(jul 02 1):b2495.doi:10.1136/bmj.b2495
59.
CharmanCR.VennAJ.WilliamsHC. The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients’ perspective. Arch Dermatol. 2004;140(12):1513-1519.doi:10.1001/archderm.140.12.1513
60.
SpulsPI.GerbensLAA.SimpsonEet al. Patient-Oriented eczema measure (POEM), a core instrument to measure symptoms in clinical trials: a harmonising outcome measures for eczema (HOME) statement. Br J Dermatol. 2017;176(4):979-984.doi:10.1111/bjd.15179
61.
HonKLE.LeungTF.WongY.FokTF. Lesson from performing SCORADs in children with atopic dermatitis: subjective symptoms do not correlate well with disease extent or intensity. Int J Dermatol. 2006;45(6):728-730.doi:10.1111/j.1365-4632.2005.02703.x
62.
Lewis-JonesMS.FinlayAY. The children’s dermatology life quality index (CDLQI): initial validation and practical use. Br J Dermatol. 1995;132(6):942-949.doi:10.1111/j.1365-2133.1995.tb16953.x
63.
Lewis-JonesMS.FinlayAY.DykesPJ. The infants’ dermatitis quality of life index. Br J Dermatol. 2001;144(1):104-110.doi:10.1046/j.1365-2133.2001.03960.x
64.
BasraMKA.Sue-HoR.FinlayAY. The family dermatology life quality index: measuring the secondary impact of skin disease. Br J Dermatol. 2007;156(3):528-538.doi:10.1111/j.1365-2133.2006.07617.x
65.
BasraMKA.EdmundsO.SalekMS.FinlayAY. Measurement of family impact of skin disease: further validation of the family dermatology life quality index (FDLQI). J Eur Acad Dermatol Venerol. 2008;22(7):813-821.doi:10.1111/j.1468-3083.2008.02593.x
66.
ChamlinSL.LaiJ-S.CellaDet al. Childhood atopic dermatitis impact scale: reliability, discriminative and concurrent validity, and responsiveness. Arch Dermatol. 2007;143(6):768-772.doi:10.1001/archderm.143.6.768
67.
HonKL.NgWGG.KungJSC.ChengNS.NgDKK.LeungTF. Utility of the pediatric allergic disease quality of life questionnaire for childhood eczema. Br J Dermatol. 2019;181(2):290-295.doi:10.1111/bjd.17710
68.
HeinlD.ChalmersJ.NankervisH.ApfelbacherCJ. Eczema trials: quality of life instruments used and their relation to patient-reported outcomes. A systematic review. Acta Derm Venereol. 2016;96(5):596-601.doi:10.2340/00015555-2322
69.
HeinlD.PrinsenCAC.SachTet al. Measurement properties of quality-of-life measurement instruments for infants, children and adolescents with eczema: a systematic review. Br J Dermatol. 2017;176(4):878-889.doi:10.1111/bjd.14966
70.
TadaJ. Diagnostic standard for atopic dermatitis. JMAJ. 2002;45(11):460-465.
71.
HanifinJM.ThurstonM.OmotoMet al. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI evaluator group. Exp Dermatol. 2001;10(1):11-18.doi:10.1034/j.1600-0625.2001.100102.x
72.
RehalB.ArmstrongA. Correction: health outcome measures in atopic dermatitis: a systematic review of trends in disease severity and quality-of-life instruments 1985–2010. PLoS One. 2011;6(6):1-7.doi:10.1371/annotation/6d5e99c5-bd8f-4cef-b77a-fbb795633da0
