Atopic dermatitis in children: clinical picture, diagnosis and treatment
EBM Guidelines
Jul 9, 2021 • Latest change Jun 1, 2023
Table of contents
Extract
- Atopic dermatitis is a chronic, itching, inflammatory skin disease characterized by exacerbations that are difficult to foresee.
- In most children, atopic dermatitis is mild and has a favourable prognosis. The condition is managed in primary health care.
- The diagnosis is based on patient history and clinical examination. Itching and the typical appearancea and location of the dermatitis are often sufficient for diagnosis. The disease starts in 70% of the cases by the age of 2 years and it is associated with chronic or constantly recurring inflammation of the skin in areas typical for different ages. The skin is dry and the eczema is erythematous, showing papules, itching, and there are often signs of scratching, crusts and lichenification. Laboratory tests or allergy investigations are not needed .
- In infants less than one year of age with severe atopic dermatitis, the possibility of food allergy as an aggravating factor should be kept in mind and an assessment carried out in specialized care may be warranted. In other patient groups there is usually no need to search for food allergy.
- There are no known effective prophylactic measures.
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Linked evidence summaries
- Most moisturisers appear to be effective in reducing flares and having a corticosteroid-sparing effect compared to placebo, vehicle or no moisturiser for the treatment of eczema.B
- Topical pimecrolimus appears to be more effective than vehicle but less effective than moderate and potent corticosteroids and 0.1% tacrolimus. The therapeutic role of topical pimecrolimus is uncertain due to the absence of key comparisons with mild corticosteroids.B
- Topical tacrolimus appears to be effective for moderate and severe atopic dermatitis in adults and children compared with vehicle ointment. Tacrolimus 0.1% appears to be better than low-potency corticosteroids, pimecrolimus 1%, and tacrolimus 0.03%.B
- Probiotics may not be an effective treatment for eczema in children.C
Search terms
Allergology, Child, Dermatitis, Atopic, Dermatology, Food Hypersensitivity, Intradermal Tests, L20*, Paediatrics, Radioallergosorbent Test, atopic dermatitis, atopic eczema, atopy, infantile eczema, nummular atopic eczema, saddle block exanthema, seborrheic infantile eczema