The Consensus Conference on Pediatric Atopic Dermatitis

Abstract

Source: Eichenfield LF, Hanifin JM, Luger TA, et al. Consensus Conference on Pediatric Atopic Dermatitis. J Am Acad Dermatol 2003;49:1088–1095.A recent consensus conference convened by the American Academy of Dermatology addressed the epidemiology, pathogenesis, and treatment of atopic dermatitis (AD) in children. The disease is now recognized as a syndrome consisting of pruritus, typical morphology and age-specific patterns, and a chronic or relapsing history, associated with early age of onset, atopy, xerosis, and a combination of accompanying, less specific clinical findings such as keratosis pilaris, white dermographism, and lichenification. AD results from a number of immunologic, neurochemical, and genetic factors, although which factors predominate remains uncertain. Controversies remain regarding the role of food allergens, the mode and timing of exposures, and the role of food avoidance in the pathogenesis of AD.With regard to therapy of AD there were several areas of consensus:Conflicting or lack of data regarding the utility, safety, and efficacy of other therapies in the pediatric population, including antihistamines, topical and systemic antibiotics, avoidance of environmental allergens, phototherapy, tar/coal tar solutions, systemic immunomodulators, and alternative or complementary therapies, all of which warrant further, rigorous investigation.Despite uncertainties, consensus exists in a number of areas, particularly with regard to the management of AD in children. Although steroid phobia has prompted some to shift away from topical steroids, these agents remain the first choice of many experienced clinicians because they are effective and safe when used under medical supervision. Newer topical immunomodulators are an exciting new therapeutic alternative with the promise of fewer side effects, but should be used with some caution because of our relative lack of experience with these drugs, and the potential for delayed adverse effects that might not manifest for many years to come.1 (See AAP Grand Rounds, June 2003;9:65–66. Also see Arvola, et al2 in the March issue of AAP Grand Rounds, 2004;11:30).