Abstract

BackgroundAtopic dermatitis (AD) is the most common immune-mediated skin disease in childhood. Several treatment options for pediatric AD, both topical and systemic, are currently available. We carried out a single-center observational study with the aim of describing characteristics and treatment patterns in pediatric AD patients.MethodsThe study included 867 patients aged ≤16 years (females 50.5%, mean patient’s age 5.9 years, standard deviation ±3.6 years) with a previous doctor-confirmed diagnosis of AD who underwent balneotherapy at the Comano Thermal Spring Water Center (Comano, Trentino, Italy) from April to October 2014.ResultsAmong the patients included in the study, 41.2% had mild (SCORing Atopic Dermatitis, SCORAD 0-15), 43.6% moderate (SCORAD 16–40) and 15.2% severe AD (SCORAD > 40). A higher occurrence of reported food allergy was observed among children with more severe AD (p < 0.0001), while no association was found between AD severity and reported inhalant allergy or passive smoking (p = 0.15 and 0.92, respectively). Emollients (55.1%) and topical corticosteroids (TCS; 45.7%) were the main treatment options used in the previous month. The use of oral steroids and topical calcineurin inhibitors (TCI) was considerably less common (6.3 and 4.5%, respectively), while no patients were on systemic agents other than steroids. Among patients with severe AD, 9.8% had not used TCS, TCI or any systemic treatments. Moreover, 20.0% of the patients in the study population had followed elimination diets, although only 27.2% of them had a reported food allergy.ConclusionsA significant difference in the prevalence of reported food allergy emerged across the different AD severity categories. Furthermore, although further data are necessary to confirm our findings, undertreatment in children with AD appeared to be very common, at least among those attending the Comano Thermal Spring Water Center. Moreover, many patients followed elimination diets in the absence of reported food allergy.

Highlights

  • Atopic dermatitis (AD) is the most common chronic immune-mediate skin disease in childhood, with a lifetime prevalence ranging between 15 and 20% [1]

  • Topical treatments are the main management options for mild to severe AD in children. They include emollients, topical corticosteroids (TCS), topical calcineurin inhibitors (TCI) and, currently, crisaborole, which is mostly used in the United States

  • In 54.3% of the children, AD had first appeared before 6 months of age

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Summary

Introduction

Atopic dermatitis (AD) is the most common chronic immune-mediate skin disease in childhood, with a lifetime prevalence ranging between 15 and 20% [1]. Topical treatments are the main management options for mild to severe AD in children. They include emollients, topical corticosteroids (TCS), topical calcineurin inhibitors (TCI) and, currently, crisaborole, which is mostly used in the United States. “Corticosteroid phobia” was the subject of a recent systematic review that included 16 studies and reported a prevalence ranging between 21.0 and 83.7% worldwide [7]. This phenomenon is rooted in patients’ irrational fears of TCS-triggered skin side effects [8, 9]. We carried out a single-center observational study with the aim of describing characteristics and treatment patterns in pediatric AD patients

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