Childhood atopic dermatitis

Childhood atopic dermatitis is a chronic inflammatory skin disease that causes dryness, intense itching and repeated flare-ups of eczema.

It is one of the most frequent skin conditions in childhood and usually begins during the first year of life. It is not contagious and it is not caused by a lack of hygiene.

Most children improve progressively with growth, although some continue to present flare-ups during adolescence or adulthood.

Atopic dermatitis is produced by the combination of several factors:

• Alteration of the protective barrier of the skin.
• Genetic predisposition.
• Alterations of the immune system.
• Environmental factors.

Having a less effective skin barrier, the skin loses water easily and allows the entry of irritant substances and allergens, favouring inflammation.

There are factors that can trigger or worsen flare-ups: heat and sweat, intense cold, aggressive soaps, wool clothing or rough fabrics, stress, infections and very dry air.

Although some children present food allergies, atopic dermatitis is not usually caused by foods, so restrictive diets should not be followed without medical indication.

The main symptoms are intense itching, very dry skin, redness, scaling and eczema plaques. The location varies according to age.

Infants. It frequently appears on the cheeks, the forehead, the scalp, the trunk and the extensor surfaces of the arms and legs. The nappy area is usually spared.

Older children. The lesions predominate in the folds of the elbows, behind the knees, the neck, the wrists and the ankles. In persistent cases, thickening of the skin (lichenification), fissures and crusts from scratching may appear.

The diagnosis is clinical. The paediatrician or the doctor specialising in skin health will assess:

• The distribution of the lesions.
• The appearance of the eczema.
• The intensity of the itching.
• The personal and family history of atopy (asthma, allergic rhinitis or atopic dermatitis).

Complementary tests are not usually necessary. Allergy tests are only requested when there are data that really make an associated allergy suspicious.

The objective of the treatment is to control the flare-ups, relieve the itching and restore the skin barrier.

Daily moisturising. It is the basis of the treatment. It is recommended to apply emollient creams once or twice a day, to use products specific for atopic skin and to maintain moisturising even when there are no lesions.

Topical corticosteroids. During flare-ups, topical corticosteroids adapted to the age, location and severity are usually used. When used correctly and under medical supervision, they are safe and very effective treatments.

Calcineurin inhibitors. In certain sensitive areas or for maintenance treatments, tacrolimus and pimecrolimus can be used. These medications do not contain corticosteroids.

New treatments. In moderate or severe cases, more advanced treatments may be necessary, such as phototherapy (in selected children), systemic immunosuppressants, biologics such as dupilumab and JAK inhibitors in carefully selected patients and according to the approved indications.

Treatment of infections. When there is an associated bacterial or viral infection, it will be necessary to treat it specifically.

Moisturise the skin every day, avoid very hot and prolonged baths, use mild soaps or bath oils, dry the skin with small touches without rubbing, apply the moisturising cream immediately after the bath, keep the nails short to reduce lesions from scratching, use cotton clothing and avoid rough fabrics, and maintain a pleasant room temperature avoiding excess heat.

You should consult your paediatrician or a doctor specialising in skin health if the itching prevents the child from sleeping, if the flare-ups are very frequent, if the lesions do not improve with the usual treatment, if pus, yellowish crusts or fever appear, if the eczema affects a large body surface or if there are doubts about the diagnosis.

• Myth: Atopic dermatitis is caused by poor hygiene. Fact: No. It is an inflammatory disease related to an alteration of the skin barrier and the immune system.
• Myth: Children with atopic dermatitis should not bathe. Fact: They can bathe. Short baths with warm water and mild products are recommended.
• Myth: Topical corticosteroids are dangerous. Fact: Used correctly and under medical supervision they are safe and constitute one of the most effective treatments.
• Myth: Many foods must be eliminated from the diet. Fact: Foods should only be removed when there is a demonstrated allergy.
• Myth: Atopic dermatitis is contagious. Fact: It cannot be transmitted to other people.

• Atopic dermatitis is a very frequent chronic inflammatory disease in childhood.
• It produces dry skin, eczema and intense itching.
• Daily moisturising constitutes the basis of the treatment.
• Topical corticosteroids are safe when used correctly.
• Restrictive diets should not be followed without a demonstrated food allergy.
• There are very effective treatments for moderate and severe cases.
• Good daily skin care reduces the frequency and intensity of the flare-ups.