Advertisement

Treatment of Infants with Atopic Dermatitis

  • Ulrich Wahn
Part of the Allergy Frontiers book series (ALLERGY, volume 5)

Atopic dermatitis (AD) is a chronic inflammatory pruritic skin disease that affects a large number of children in industrialized countries [1]. The 12 month prevalence in 11-year-old children, as studied in the Global International Study of Asthma and Allergies in Childhood trial, ranged from 1 to 20%, with the highest prevalence typically found in Northern Europe [1, 2].

In 45% of children, the onset of AD occurs during the first 6 months of life, during the first year of life in 60%, and before the age of 5 years in at least 85% of the affected individuals. In those children with onset before the age of 2 years, 20% will have persisting manifestations of the disease, and an additional 17% will have intermittent symptoms by the age of 7 years (Fig. 1). A risk factor for persistent AD symptoms is the severity of disease in infancy [3].

Keywords

Atopic Dermatitis Food Allergy Fluticasone Propionate Allergy Clin Immunol Food Allergen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Anonymous. Worldwide variation in prevalence of symptoms of asthma, allergic rhinocon-junctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Lancet 1998;351:1225–1232Google Scholar
  2. 2.
    Kay J, Gawkrodger DJ, Mortimer MJ, Jaron AG. The prevalence of childhood atopic eczema in a general population. J Am Acad Dermatol 1994;30:35–39CrossRefPubMedGoogle Scholar
  3. 3.
    Illi S, von Mutius E, Lau S, Nickel R, Gruber C, Niggemann B, et al. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. J Allergy Clin Immunol 2004;113:925–931CrossRefPubMedGoogle Scholar
  4. 4.
    Purvis DJ, Thompson JM, Clark PM, Robinson E, Black PN, Wild CJ, et al. Risk factors for atopic dermatitis in New Zealand children at 3.5 years of age. Br J Dermatol 2005;152:742–749CrossRefPubMedGoogle Scholar
  5. 5.
    Hoffjan S, Epplen JT. The genetics of atopic dermatitis: recent findings and future options. J Mol Med 2005;83:682–692CrossRefPubMedGoogle Scholar
  6. 6.
    Lee YA, Wahn U, Kehrt R, Tarani L, Businco L, Gustafsson D, et al. A major susceptibility locus for atopic dermatitis maps to chromosome 3q21. Nat Genet 2000;26:470–473CrossRefPubMedGoogle Scholar
  7. 7.
    Morar N, Willis-Owen S, Moffatt M, Cookson W. The genetics of atopic dermatitis. J. Allergy Clin Immunol 2006;118:24CrossRefPubMedGoogle Scholar
  8. 8.
    Akdis CA, Akdis M, Bieber T, et al.Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol 2006;118:152–169CrossRefPubMedGoogle Scholar
  9. 9.
    Novak N, Bieber T, Leung D Y. Immune mechanisms leading to atopic dermatitis. J Allergy Clin Immunol 2003;112(Suppl):S128–S39CrossRefPubMedGoogle Scholar
  10. 10.
    Seidenari S, Giusti G. Objective assessment of the skin of children affected by atopic dermatitis: a study of pH, capacitance and TEWL in eczematous and clinically uninvolved skin. Acta Derm Venereol 1996;75:429–433Google Scholar
  11. 11.
    Sator PG, Schmidt JB, Honigsmann H. Comparison of epidermal hydration and skin surface lipids in healthy individuals and in patients with atopic dermatitis. J Am Acad Dermatol 2003;48:352–358CrossRefPubMedGoogle Scholar
  12. 12.
    Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics 1998;101:e8CrossRefPubMedGoogle Scholar
  13. 13.
    Werfel T, Breuer K. Role of food allergy in atopic dermatitis. Curr Opin Allergy Clin Immunol 2004;4:379–385CrossRefPubMedGoogle Scholar
  14. 14.
    Schafer T, Heinrich J, Wjst M, Adam H, Ring J, Wichmann HE. Association between severity of atopic eczema and degree of sensitization to aeroallergens in schoolchildren. J Allergy Clin Immunol 1999;104:1280–1284CrossRefPubMedGoogle Scholar
  15. 15.
    Abeck D, Mempel M. Staphylococcus aureus colonisation in atopic dermatitis and its therapeutic implications. Br J Dermatol 1998;139:13–16CrossRefPubMedGoogle Scholar
  16. 16.
    Arikawa J, Ishibashi M, Kawashima M, Takagi Y, Ichikawa Y, Imokawa G. Decreased levels of sphingosine, a natural antimicrobial agent, may be associated with vulnerability of the stratum corneum from patients with atopic dermatitis to colonization by Staphylococcus aureus. J Invest Dermatol 2002;119:433–439CrossRefPubMedGoogle Scholar
  17. 17.
    Breuer K, Kapp A, Werfel T. Bacterial infections and atopic dermatitis. Allergy 2001;56:1034–1041CrossRefPubMedGoogle Scholar
  18. 18.
    Leung DY. Infection in atopic dermatitis. Curr Opin Pediatr 2003;15:399–404PubMedGoogle Scholar
  19. 19.
    Rippke F, Schreiner V, Doering T, Maibach HI. Stratum corneum pH in atopic dermatitis: impact on skin barrier function and colonization with Staphylococcus aureus. Am J Clin Dermatol 2004;5:217–223CrossRefPubMedGoogle Scholar
  20. 20.
    Leung DYM, Harbeck H, Bina P, Reiser RF, Yang E, Norris AD, et al. Presence of IgE antibodies to staphylococcal enterotoxins on the skin of patients with atopic dermatitis: evidence for a new group of allergens. J Clin Invest 1993;92:1374–1380CrossRefPubMedGoogle Scholar
  21. 21.
    Novak N, Allam JP, Bieber T. Allergic hyperreactivity to microbial components: a trigger factor of “intrinsic” atopic dermatitis? J Allergy Clin Immunol 2003;112:215–216CrossRefPubMedGoogle Scholar
  22. 22.
    Celik-Bilgili S, Mehl A, Verstege A, Staden U, Nocon M, Beyer K, et al. The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy 2005;35:268–273CrossRefPubMedGoogle Scholar
  23. 23.
    Osterballe M, Bindslev-Jensen C. Threshold levels in food challenge and specific IgE in patients with egg allergy: is there a relationship? J Allergy Clin Immunol 2003;112:196–201CrossRefPubMedGoogle Scholar
  24. 24.
    Sampson HA. Food allergy — accurately identifying clinical reactivity. Allergy 2005;60(Suppl 79):19–24CrossRefPubMedGoogle Scholar
  25. 25.
    Sampson HA. Update on food allergy. J Allergy Clin Immunol 2004;113:805–819CrossRefPubMedGoogle Scholar
  26. 26.
    Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001;107:891–896CrossRefPubMedGoogle Scholar
  27. 27.
    Darsow U, Laifaoui J, Kerschenlohr K, Wollenberg A, Przybilla B, Wuthrich B, et al. The prevalence of positive reactions in the atopy patch test with aeroallergens and food allergens in subjects with atopic eczema: a European multicenter study. Allergy 2004;59:1318–1325CrossRefPubMedGoogle Scholar
  28. 28.
    Bindslev-Jensen C, Ballmer-Weber BK, Bengtsson U, Blanco C, Ebner C, Hourihane J, et al. Standardization of food challenges in patients with immediate reactions to foods — position paper from the European Academy of Allergology and Clinical Immunology. Allergy 2004;59:690–697CrossRefPubMedGoogle Scholar
  29. 29.
    Breuer K, Heratizadeh A, Wulf A, Baumann U, Constien A, Tetau D, et al. Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy 2004;34:817–824CrossRefPubMedGoogle Scholar
  30. 30.
    Ainley-Walker PF, Patel L, David TJ. Side to side comparison of topical treatment in atopic dermatitis. Arch Dis Child 1998;79:149–152CrossRefPubMedGoogle Scholar
  31. 31.
    Boguniewicz M, Nicol N. Conventional therapy. Immunol Allergy Clinics N Am 2002;22:107–124CrossRefGoogle Scholar
  32. 32.
    Darsow U, Lubbe J, Taieb A, Seidenari S, Wollenberg A, Calza AM, et al. Position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol 2005;19:286–295CrossRefPubMedGoogle Scholar
  33. 33.
    Loden M. Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders. Am J Clin Dermatol 2003;4:771–788CrossRefPubMedGoogle Scholar
  34. 34.
    Subramanyan K. Role of mild cleansing in the management of patient skin. Dermatol Ther 2004;17:26–34CrossRefPubMedGoogle Scholar
  35. 35.
    Kerscher MJ, Hart H, Korting HC, Stalleicken D. In vivo assessment of the atrophogenic potency of mometasone furoate, a newly developed chlorinated potent topical glucocorticoid as compared to other topical glucocorticoids old and new. Int J Clin Pharmacol Ther 1995;33:187–189PubMedGoogle Scholar
  36. 36.
    Korting HC, Kerscher MJ, Schafer-Korting M. Topical glucocorticoids with improved benefit/ risk ratio: do they exist? J Am Acad Dermatol 1992;27:87–92CrossRefPubMedGoogle Scholar
  37. 37.
    Thomas KS, Armstrong S, Avery A, Po AL, O'Neill C, Young S, et al. Randomised controlled trial of short bursts of a potent topical corticosteroid versus prolonged use of a mild preparation for children with mild or moderate atopic eczema. BMJ 2003;30:768Google Scholar
  38. 38.
    Berth-Jones J, Damstra RJ, Golsch S, Livden JK, Van Hooteghem O, Allegra F, et al. Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study. BMJ 2003;326:1367CrossRefPubMedGoogle Scholar
  39. 39.
    Nilsson EJ, Henning CG, Magnusson J. Topical corticosteroids and Staphylococcus aureus in atopic dermatitis. J Am Acad Dermatol 1992;27:29–34CrossRefPubMedGoogle Scholar
  40. 40.
    Stalder JF, Fleury M, Sourisse M, Rostin M, Pheline F, Litoux P. Local steroid therapy and bacterial skin flora in atopic dermatitis. Br J Dermatol 1994;131:536–540PubMedCrossRefGoogle Scholar
  41. 41.
    Ashcroft DM, Dimmock P, Garside R, Stein K, Williams HC. Efficacy and tolerability of topical pimecrolimus and tacrolimus in the treatment of atopic dermatitis: meta-analysis of randomised controlled trials. BMJ 2005;330:516CrossRefPubMedGoogle Scholar
  42. 42.
    Breuer K, Werfel T, Kapp A. Safety and efficacy of topical calcineurin inhibitors in the treatment of childhood atopic dermatitis. Am J Clin Dermatol 2005;6:65–77CrossRefPubMedGoogle Scholar
  43. 43.
    Elidel [package insert]. Basel, Switzerland: Novartis Pharmaceuticals Corp.; 2006Google Scholar
  44. 44.
    Protopic [package insert]. Deerfield, IL: Astellas Pharma Manufacturing Inc.; 2006Google Scholar
  45. 45.
    Harper J, Green A, Scott G, Gruendl E, Dorobek B, Cardno B, et al. First experience of topical SDZ ASM 981 in children with atopic dermatitis. Br J Dermatol 2001;144:781–787CrossRefPubMedGoogle Scholar
  46. 46.
    Hultsch T, Kapp A, Spergel J. Immunomodulation and safety of topical calcineurin inhibitors for the treatment of atopic dermatitis. Dermatology 2005;211:174–187CrossRefPubMedGoogle Scholar
  47. 47.
    Paul C, Cork M, Rossi AB, Papp KA, Barbier N, de Prost Y. Safety and tolerability of 1% pimecrolimus cream among infants: experience with 1133 patients treated for up to 2 years. Pediatrics 2006;117:118–128CrossRefGoogle Scholar
  48. 48.
    Wahn U, Bos JD, Goodfield M, Caputo R, Papp K, Manjra A, et al. Efficacy and safety of pimecrolimus cream in the long-term management of atopic dermatitis in children. Pediatrics 2002;110:e2CrossRefPubMedGoogle Scholar
  49. 49.
    Kempers S, Boguniewicz M, Carter E, Jarratt M, Pariser D, Stewart D, et al. A randomized inverstigator-blinded study comparing pimecrolimus cream 1% with tacrolimus 0.03% in the treatment of pediatric patients with moderate atopic dermatitis. J Am Acad Dermatol 2004;51:515–525CrossRefPubMedGoogle Scholar
  50. 50.
    Queille-Roussel C, Paul C, Duteil L, Lefebvre MC, Rapatz G, Zagula M, et al. The new topical ascomycin derivate SDZ ASM 981 does not induce skin atrophy when applied to normal skin for 4 weeks: a randomized, double-blind controlled study. Br J Dermatol 2001;144:507–513CrossRefPubMedGoogle Scholar
  51. 51.
    Foelster-Holst R, Nagel F, Zoellner P, Spaeth D. Efficacy of crisis intervention treatment with topical corticosteroid prednicarbat with and without partial wet-wrap dressing in atopic dermatitis. Dermatology 2006;212:66–69CrossRefPubMedGoogle Scholar
  52. 52.
    Mallon E, Powell S, Bridgman A. “Wet-wrap” dressings for the treatment of atopic eczema in the community. J Dermatolog Treat 1994;5:97–98CrossRefGoogle Scholar
  53. 53.
    Ricci G, Patrizi A, Bendandi B, Menna G, Varotti E, Masi M. Clinical effectiveness of a silk fabric in the treatment of atopic dermatitis. Br J Dermatol 2004;150:127–131CrossRefPubMedGoogle Scholar
  54. 54.
    Sporik R, Kemp AS. Topical triclosan treatment of atopic dermatitis. J Allergy Clin Immunol 1997;99:861CrossRefPubMedGoogle Scholar
  55. 55.
    Gauger A, Mempel M, Schekatz A, Schafer T, Ring J, Abeck D. Silver-coated textiles reduce Staphylococcus aureus colonization in patients with atopic eczema. Dermatology 2003;207:15–21CrossRefPubMedGoogle Scholar
  56. 56.
    Verbist I. The antimicrobial activity of fucidic acid. J Antimicrob Chemother 1990;25(Suppl B):1–5PubMedGoogle Scholar
  57. 57.
    Boguniewicz M, Sampson H, Harbeck R, Leung DYM. Effects of cefuroxime axetil on S. aureus colonization and superantigen production in atopic dermatitis. J Allergy Clin Immunol 2001;108:651–652CrossRefPubMedGoogle Scholar
  58. 58.
    Hoeger PH. Antimicrobial susceptibility of skin-colonizing S. aureus strains in children with atopic dermatitis. Pediatr Allergy Immunol 2004;15:474–477CrossRefPubMedGoogle Scholar
  59. 59.
    Ravenscroft JC, Layton A, Barnham M. Observations on high levels of fusidic acid resistant Staphylococcus aureus in Harrogate, North Yorkshire, UK. Clin Exp Dermatol 2000;25:327–330CrossRefPubMedGoogle Scholar
  60. 60.
    Wollenberg A, Zoch C, Wetzel S, Plewig G, Przybilla B. Predisposing factors and clinical features of eczema herpeticum: a retrospective analysis of 100 cases. J Am Acad Dermatol 2003;49:198–205CrossRefPubMedGoogle Scholar
  61. 61.
    Lintu P, Savolainen J, Kortekangas-Savolainen O, Kalimo K. Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts. Allergy 2001;56:512–517CrossRefPubMedGoogle Scholar
  62. 62.
    Aylett SE, Atherton DJ, Preece MA. The treatment of difficult atopic dermatitis in childhood with oral beclomethasone dipropionate. Acta Derm Venereol Suppl 1992;176:123–125Google Scholar
  63. 63.
    Anonymous. Worldwide variation in prevalence of symptoms of asthma, allergic rhinocon-junctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Lancet 1998;351:1225–1232Google Scholar
  64. 64.
    Berth-Jones J, Finlay AY, Zaki I, Tan B, Goodyear H, Lewis-Jones S, et al. Cyclosporine in severe childhood atopic dermatitis: a multicenter study. J Am Acad Dermatol 1996;34:1016–1021CrossRefPubMedGoogle Scholar
  65. 65.
    Hauk PJ, Leung DYM. Tacrolimus (FK506): new treatment approach in superantigen-associated diseases like atopic dermatitis? J Allergy Clin Immunol 2001;107:391–392CrossRefPubMedGoogle Scholar
  66. 66.
    Zaki I, Emerson R, Allen BR. Treatment of severe atopic dermatitis in childhood with cyclosporin. Br J Dermatol 1996;135(Suppl 48):21–24CrossRefPubMedGoogle Scholar
  67. 67.
    Diepgen TL. Early Treatment of the Atopic Child Study Group. Long-term treatment with cetirizine of infants with atopic dermatitis: a multi-country, double-blind, randomized, placebo-controlled trial (the ETAC trial) over 18 months. Pediatr Allergy Immunol 2002;13:278–286CrossRefPubMedGoogle Scholar
  68. 68.
    Wahlgren C-F, Hagermark O, Bergstrom R. The antipruritic effect of a sedative and a nonsedative antihistamine in atopic dermatitis. Br J Dermatol 1990;122:545–551CrossRefPubMedGoogle Scholar
  69. 69.
    Warner JO. ETAC Study Group. A double-blinded, randomized, placebo-controlled trial of cetirizine in preventing the onset of asthma in children with atopic dermatitis: 18 months' treatment and 18 months' posttreatment follow-up. J Allergy Clin Immunol 2001;108:929–937CrossRefPubMedGoogle Scholar
  70. 70.
    Staab D, Diepgen T, Fartasch M, Kupfer J, Lob-Corzilius T, Ring J, et al. Age-related, structured education programmes improve the management of atopic dermatitis in children and adolescents: results of the German Atopic Dermatitis Intervention Study (GADIS). BMJ 2006;332:933–938CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  1. 1.Department for Pediatric Pneumology and ImmunologyCharité BerlinGermany

Personalised recommendations