ABSTRACT

Atopic dermatitis in children

Atopic dermatitis (AD) is a genetically determined disease triggered/exacerbated by environmental factors. AD is a chronic and recurrent inflammatory skin disease that affects the epidermis and the dermis. It is characterized by severe itching and skin lesions with a specific morphology and location, characteristic of particular periods of human life.

The clinical presentation of atopic dermatitis varies depending on the patient’s age (actually, on the thickness of the skin and its histopathological maturity), disease activity and duration. The different structure of the skin in the youngest children, coexisting with filaggrin gene defects, predisposes to early-onset atopic dermatitis and the separation of infantile-type and childhood-type atopic dermatitis in children.

AD is diagnosed based on clinical features, typical appearance and distribution of skin lesions in the specific development periods.

Emollients provide the basis for all therapeutic strategies. Topical corticoids (glucocorticoids, GCs) should be used as a second-choice option. They are the first-choice option for the treatment of skin inflammation and acute inflammation. They should be applied using appropriate force according to the patient’s age and the site of administration. The next option are topical calcineurin inhibitors which are perfect for suppressing and calming subclinical inflammation. The next stage is phototherapy. In severe and very severe cases, systemic drugs are used: cyclosporine, methotrexate and dupilumab.

It is very important to provide the patient with comprehensive multidisciplinary care, especially in atopic schools, and to refer the patient to a psychologist who will help them cope with the stress caused by chronic and recurrent disease and stigmatization.