Pearls for Management of Pediatric Atopic Dermatitis

At the recently held 2024 American Academy of Dermatology (AAD) Innovation Academy dermatologist Lisa Swanson, MD, FAAD, presented new insights into pediatric atopic dermatitis (AD), emphasizing its wide-ranging impact on children's health, including increased risks of food allergies, infections, and systemic comorbidities.

Dr. Swanson, a dermatologist at Ada West Dermatology and St. Lukes Children’s Hospital, covered the far-reaching effects of pediatric atopic dermatitis (AD), a condition her wide-ranging presentation noted was often underestimated in its complexity. She also highlighted growing evidence that AD (traditionally viewed as a skin condition) is associated with significant systemic health risks in children.

Food Allergies

One of the key focuses of her presentation focused on the relationship between AD and food allergies. According to recent studies shared by Dr. Swanson, children with facial involvement of AD are at a notably increased risk of developing food allergies. By the age of three, food sensitization rates to common allergens, including cow’s milk, egg whites, and peanuts, were found to be 48% higher in children with facial AD compared to those without facial AD. This growing body of evidence, she noted, suggests that impaired skin barriers in AD may allow allergens to penetrate the body and trigger immune responses, rather than food allergies acting as the driver of AD flare-ups.

Systemic Impact of AD

Dr. Swanson also addressed the broader systemic impact of AD. Children with AD are more prone to bacterial, viral, and fungal infections due to compromised skin defenses. In addition, the long-term use of topical steroids to manage AD symptoms can contribute to complications such as osteoporosis, stunted growth, and increased fracture risk. She pointed out that these systemic risks are not limited to infections but extend to a higher likelihood of asthma, cardiovascular diseases, and other inflammatory conditions.

Sleep Disturbances 

Sleep disturbances also play a crucial role in the lives of children with AD. Dr. Swanson noted that children often experience poor-quality sleep, particularly due to reduced REM cycles, which directly affects growth hormone secretion. This physiological disruption can explain the smaller stature commonly observed in children with severe AD and is linked to further bone development issues such as osteopenia and osteoporosis.

Other Consequences of AD

Dr. Swanson also touched on the neurological and psychological consequences of AD, explaining that children with severe AD are at an elevated risk of developing attention deficit hyperactivity disorder (ADHD), anxiety, depression, and even autism spectrum disorders. There was also research in her review indicating IL-4, a cytokine active in AD, might impair brain myelination, contributing to potential developmental delays and cognitive impairments.

Treatment Options

The presentation included a summary of emerging treatment options for pediatric AD, including non-steroidal treatments like topical ruxolitinib and roflumilast creams, which offer promising efficacy without the long-term risks associated with steroids. Additionally, biologics such as dupilumab, now approved for children as young as six months, are showing significant benefits in reducing AD severity and potentially mitigating some of its systemic effects, including the need for ADHD medications in affected children.

Overall, Dr. Swanson’s presentation underscored that pediatric AD is not merely a dermatological condition but a multifaceted disorder with broad implications for child health, requiring comprehensive management strategies.

Source: Swanson L. Tips and Tricks for Peds Management of Atopic Dermatitis. Presented at: 2024 AAD Innovation Academy.