Abstract
IntroductionAtopic dermatitis is a chronic, pruritic, eczematous skin disease mediated through an immediate (type I) hypersensitivity reaction. Posterior sub-capsular cataracts are a recognised complication of atopic dermatitis in adults; however they are rare in children. The management of atopic dermatitis is based on the exclusion of allergens, the use of emollients, and on topical corticosteroids for disease exacerbations. Cataracts may be due to atopic dermatitis but may also occur secondary to the use of corticosteroids.Case presentationWe describe two children with atopic dermatitis, treated with cutaneous corticosteroids, both of whom were diagnosed with bilateral posterior sub-capsular cataracts.ConclusionThese cases demonstrate that atopic dermatitis and topical corticosteroids may be associated with cataracts in children as well as adults. The cause of cataracts in atopic dermatitis is not known, however, it has been suggested that habitual tapping and rubbing of the face may play a role. Care needs to be taken when prescribing corticosteroids. Inadequate treatment of atopic dermatitis may lead to other ocular complications such as keratitis and permanent visual loss.
Highlights
Atopic dermatitis is a chronic, pruritic, eczematous skin disease mediated through an immediate hypersensitivity reaction
Case presentation: We describe two children with atopic dermatitis, treated with cutaneous corticosteroids, both of whom were diagnosed with bilateral posterior sub-capsular cataracts
These cases demonstrate that atopic dermatitis and topical corticosteroids may be associated with cataracts in children as well as adults
Summary
Corticosteroids are known to cause posterior sub-capsular cataract by most routes of administration. Myopia and glaucoma, steroid use is the fourth leading risk factor for secondary cataract and accounts for 4.7% of all cataract extractions [2]. Care needs to be taken when prescribing corticosteroids, in children who have a lower susceptibility to side effects. Corticosteroids are frequently required to adequately treat AD, to limit pruritus and prevent complications such as keratitis that can lead to permanent visual loss. Many patients and parents have negative perceptions regarding the use of steroids, which may lead to inadequate treatment of the skin disease and increased eye rubbing. The increasing use of alternative specific immunosuppressants that lack the side effect profile of corticosteroids may reduce the incidence of cataracts in these patients
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