Update on Pediatric Atopic Dermatitis

Abstract

WWW.MDEDGE.COM/DERMATOLOGY CLINICAL REVIEW Recent studies have led to new insights into atopic dermatitis (AD) pathogenesis and epidemiology as well as its impact on the quality of life of affected children and adolescents. In addition, there are several novel topical and systemic agents recently approved and in late-stage clinical development programs. Epidemiologic insights include relative prevalence rates in different countries and studies of subsets of pediatric patients with different disease longevity and persistence. Studies on quality of life have shown tremendous impact on sleep, not only in affected individuals but in their parents/guardians. The impact of bathing regimens is discussed. Newer topical therapies are reviewed, including topical crisaborole, with a new indication for infants as young as 3 months of age. Topical Janus kinase (JAK) inhibitors are being developed, with some studies including adolescents and children. Other novel therapies include the topical aryl hydrocarbon receptor agonist tapinarof and oral JAK inhibitors; adolescents are being included in the initial clinical trials for several of these therapies. Dupilumab, the first biologic agent approved for AD, has now been well studied in patients aged 6 years and older, with expanded indication down to 6 years of age.

Recent Developments and Advances in Atopic Dermatitis: A Focus on Epidemiology, Pathophysiology, and Treatment in the Pediatric Setting

“…Similarly, a questionnaire-based survey of 91,642 children in the United States between the ages of 0 and 17 years found that children with AD had a higher chance of experiencing four or more nights of impaired sleep per year [1,41]. This effect was even more pronounced in children with severe AD than in those with mild or moderate AD [1,41].…”

“…In a longitudinal cohort study following 13,988 children in the United Kingdom from the ages of 2 to 16 years, it was found that children with any form of AD, even mild or inactive AD, had statistically significantly increased odds of poor sleep quality, and that children with active AD were almost 50% more likely to encounter increased disturbances to their sleep throughout childhood [40]. Similarly, a questionnaire-based survey of 91,642 children in the United States between the ages of 0 and 17 years found that children with AD had a higher chance of experiencing four or more nights of impaired sleep per year [1,41]. This effect was even more pronounced in children with severe AD than in those with mild or moderate AD [1,41].…”

Impact of Crisaborole on Sleep Outcomes in Pediatric Patients with Mild-to-Moderate Atopic Dermatitis

“…AD flares also exacerbate negative impact on sleep [ 2 , 5 ]. A USA-based survey of more than 90,000 children aged 0–17 years revealed that children who reported having AD within the past year had a higher chance of experiencing impaired sleep, and children with severe AD reported more instances of sleep disruption than children with mild or moderate AD [ 5 , 6 ]. Similarly, a cohort study of almost 14,000 British children aged 2–16 years found that children with AD, even those with cases of mild or inactive disease, had significantly worse sleep quality relative to children without AD [ 7 ].…”

Design and Evaluation of Paeonol-Loaded Liposomes in Thermoreversible Gels for Atopic Dermatitis

“…[ 3 , 4 , 5 ]. Its onset is usually concentrated in early childhood, but 2–10% of adults have AD, leading to a significant decrease in quality of life and increased psychological burdens [ 6 , 7 , 8 , 9 ]. The factors causing AD are not clear at present, but are mainly attributed to filaggrin (FLG), resulting in impaired skin barrier function [ 10 ] and changes in immune system function [ 11 , 12 ].…”