Characterization of Classical Flexural and Nummular Forms of Atopic Dermatitis in Childhood with Regard to Anamnestic, Clinical and Epidermal Barrier Aspects

Abstract

Nummular (coin-shaped) and classical (flexural) atopic dermatitis differ morphologically, but no other distinguishing features are known. The aim of this study was to determine differences and similarities of both variants in children. Detailed interviews, clinical examinations, biophysical measurements and electron microscopic analyses were performed on 10 children with nummular atopic dermatitis, 14 with classical atopic dermatitis and 10 healthy controls. Nummular atopic dermatitis affected more boys than girls and manifested less frequently within the first year of life than classical atopic dermatitis. Localization, distribution and morphology of the eczema varied more over time, and expression of keratosis pilaris was more severe in children with nummular atopic dermatitis. Both disease groups showed reduced hydration, increased transepidermal water loss and reduced intercellular lipid lamellae in lesional skin areas compared with non-lesional areas. These findings underline the separate classification of both variants. Further research is necessary to investigate the potential of diverging therapeutic approaches.

Prescription Patterns of Topical Medications in Patients with Atopic Dermatitis: An Investigative Review Using Big Data from the National Health Insurance Corporation

“…Thus, many topical treatments for psoriasis include Vitamin D analogs and topical keratolytics, which are helpful in blocking keratinocyte proliferation and thus alleviating hyperkeratotic lesions 16 . Furthermore, since typical AD also occurs in flexural areas 17 requiring low-potency TCS treatment, the overall potency may be relatively lower than that of psoriasis.…”

Effects of eczema calming lotion on the stratum corneum in atopic dermatitis: Corneodesmosin and intercellular lipid lamellae

“…These ICLLs play an important role in maintaining the epidermal barrier properties of the SC and are essential for good SC hydration, as their disruption or depletion can lead to barrier abnormalities. Previous studies have shown that the length of ICLL in the intercellular spaces decreases in AD [19][20][21][22][23][24][25][26][27][28][29][30]. Direct evaluation of barrier integrity or the integrity of the SC is possible by morphometric analysis and visualizing the organization of ICLL under the TEM.…”

“…Direct evaluation of barrier integrity or the integrity of the SC is possible by morphometric analysis and visualizing the organization of ICLL under the TEM. To compare ICLL in different samples, the ICLL is normalized to the area of the intercellular space (ICS) [19,20,21,22,28,29,30]. An increase in normalized ICLL length (nICLL) is evidence of better barrier functions of the skin [20][21][22].…”

Discoid (nummular) eczema in the paediatric setting – An Australian/New Zealand narrative

“…Unlike classical atopic dermatitis (AD) that often presents in infancy, DE tends to arise later in childhood 2 . It is reported to be more common in those of skin of colour 3 and in males 4 . While discoid morphology has been observed in up to 15% of children with AD, 2 there is very little in the way of evidence‐based studies on this subtype.…”

“…2 It is reported to be more common in those of skin of colour 3 and in males. 4 While discoid morphology has been observed in up to 15% of children with AD, 2 there is very little in the way of evidence-based studies on this subtype. This, therefore, leads to the need for a review paper to summarise the available evidence alongside consensus views from experienced clinicians with regards to the behaviour and management of paediatric DE.…”