A Global Review on the Risk Factors and Management of Early Atopic Dermatitis in Children Ages 0 to 2 Years Old

October 2019 | Volume 18 | Issue 10 | Original Article | 1020 | Copyright © October 2019

Lawrence A. Schachner MD FAAD FAAP,a Adelaide A. Hebert MD FAAD,B Anneke Andriessen PhD,c Latanya T. Benjamin MD FAAD FAAP,D Ana M. Duarte MD FAAD FAAP,e Norman Goldberg MD FAAP,f Pearl C. Kwong MD FAAD,g Tace Steele Rico MD FAAD,h Lawrence F. Eichenfield MD FAAD FAAPi

ªThe Phillip Frost Department of Dermatology & Cutaneous Surgery, Pediatrics;Leonard M. Miller School of Medicine, University of Miami, FL 

BPediatric Dermatology, McGovern School of Medicine, Children’s Memorial Hermann Hospital, Houston, TX; UT Physicians Dermatology–Texas Medical Center, Houston, TX 

cRadboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands

dHollywood, FL

eChildren’s Skin Center, Miami, FL

fMiami, FL

gJacksonville, FL

hFlorida Hospital for Children, University of Miami School of Medicine, AdventHealth Medical Group, Orlando, FL 

iDepartments of Dermatology and Pediatrics, University of California, San Diego and Rady Children's Hospital, San Diego, CA 

Abstract
Introduction: Atopic dermatitis (AD) is a chronic, relapsing skin disease starting typically in atopic-prone children between 3–6 months of age, with most children having developed AD by the age of 5 years. Intense itching leads to sleep disturbance, especially in younger children and toddlers. This review explores early intervention in infants and young children with AD by controlling skin barrier function and inflammation at the earliest time point using a moisturizer and a proactive treatment.

Methods: A working group of experienced clinicians managing pediatric populations with AD convened for a meeting. The panel reviewed the literature surrounding early intervention in infants and young children with AD and developed and discussed clinical questions aimed at optimizing clinical outcomes.

Results: Complex gene/immune system/environment interactions are involved in AD development. Epidermal barrier defects play a central role in the condition, with various studies showing impairment of skin barrier function at birth may precede clinical AD. Dynamic changes take place in the amounts of skin lipids during infancy. Studies confirm that daily use of a moisturizer from birth onwards may offer benefits in improving skin barrier function and possibly prevention of AD, especially in high-risk, atopic prone newborns. Plant-based moisturizers were shown to be safe and effective when applied in pediatric patients with AD and may provide a TCS-sparing effect while improving skin condition.

Conclusion: Dry skin conditions during infancy may predict the subsequent development of AD. Consequently, emollient therapy from birth represents a feasible, safe, and effective approach for AD prevention. Therefore, parental education and the application of moisturizers are recommended as an integral part of AD prevention, treatment, and maintenance.

J Drugs Dermatol. 2019;18(10):1020-1027.

INTRODUCTION

Atopic dermatitis (AD) is a relapsing, inflammatory, pruritic skin disease with a prevalence reported in industrialized countries of over 20% in children and up to 3% in adults.1,2 The onset of AD is typically between 3–6 months of age, with 90% of atopic-prone children developing AD by the age of 5 years.2 The clinical diagnosis of AD is based on the presence of one or more signs including pruritus, erythema, scaling, xerosis, edema, excoriations/erosions, oozing, crusting or lichenification.2 AD usually does not appear in the first weeks of life; the clinical presentation differs with that of adults. In children, AD presents in an age-dependent distribution with facial, scalp, and extensor involvement in infants and young children, and with predominant flexural involvement in older children.5 Intense itching leads to significant sleep disturbance, especially in younger children and toddlers.4,5 Poorer sleep than normal occurs even when the children are in remission; this lack of quality sleep may have long-term behavioral and neurocognitive effects.4,6 Sleep disturbance was reported to be more common in those children with severe disease and