Atopic Dermatitis In Infants Research Articles

DEVELOPING AN INFANT ATOPIC DERMATITIS SCORECARD FOR PEDIATRIC CLINICIANS

<h3>Introduction</h3> Accurate diagnosis and categorization of infant atopic dermatitis (AD) is necessary for assessing risk prior to early peanut introduction. AD assessment tools were primarily developed for research purposes and not for clinical use. Objective:To develop an infant AD scorecard with a focus on diverse skin tones to assist pediatric clinicians with AD assessments. <h3>Methods</h3> Parents of children with AD diagnosis were contacted and consented to provide high-resolution standardized photographs of their infant's AD lesions. Two dermatologists reviewed all images and determined AD severity using the Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD). An instructional video about AD and how to use the scorecard was developed and presented to pediatric clinicians. <h3>Results</h3> Overall, photographs of 13 children were obtained: 6 children were photographed by research staff and 7 provided images of their infants using the same standardized photographic protocol. Two pediatric dermatologists evaluated 58 infant's images, with 84% agreement on first-pass severity categorization. Of these, 14 images were selected representing 2 White, 2 Black, 1 mixed race, and 2 Hispanic/LatinX infants. These images were used to develop the final scorecard which included 5 mild, 5 moderate, and 4 severe cases of AD. Overall, 189 pediatricians completed an educational module on AD categorization and vIGA-AD scorecard. Initial feedback surveys (N=14) 64.3% reported the training was "very effective." Observation of utilization and effectiveness of the scorecard and training is ongoing. <h3>Conclusion</h3> Development of an infant AD scorecard can assist pediatric providers in assessing peanut allergy risk prior to early introduction.

Skin biomarkers predict development of atopic dermatitis in infancy.

There is currently no insight into biomarkers that can predict the onset of pediatric atopic dermatitis (AD). Nested in a prospective birth cohort study that examined the occurrence of physician-diagnosed AD in 300 children, 44 random children with onset of AD in the first year of life were matched on sex and season of birth with 44 children who did not develop AD. Natural moisturizing factor (NMF), corneocyte surface protrusions, cytokines, free sphingoid bases (SBs) of different chain lengths and their ceramides were analyzed from tape strips collected at 2months of age before onset of AD using liquid chromatography, atomic force microscopy, multiplex immunoassay, and liquid chromatography mass spectrometry, respectively. Significant alterations were observed for four lipid markers, with phytosphingosine ([P]) levels being significantly lower in children who developed AD compared with children who did not (median 240 pmol/mg vs. 540 pmol/mg, p < 0.001). The two groups of children differed in the relative amounts of SB of different chain lengths (C17, C18 and C20). Thymus- and activation-regulated chemokine (TARC/CCL17) was slightly higher in children who developed AD, whereas NMF and corneocyte surface texture were similar. AD severity assessed by the eczema area and severity index (EASI) at disease onset was 4.2 (2.0;7.2). [P] had the highest prediction accuracy among the biomarkers (75.6%), whereas the combination of 5 lipid ratios gave an accuracy of 89.4%. This study showed that levels and SB chain length were altered in infants who later developed AD, and that TARC/CCL17 levels were higher.

Lactobacillus rhamnosus Used in the Perinatal Period for the Prevention of Atopic Dermatitis in Infants: A Systematic Review and Meta-Analysis of Randomized Trials.

BackgroundNumerous systematic reviews and meta-analyses have examined the effects of probiotics used perinatally on prevention or treatment of atopic disease in infants and children. However, to date, no review has examined randomized controlled trials of Lactobacillus rhamnosus, specifically, administered both prenatally and postnatally and its effect over a long period of time.ObjectiveThe objective was to determine if L. rhamnosus either used solely or in conjunction with other probiotics demonstrates a long-term preventive effect on atopic disease in pediatric patients when used perinatally.MethodsA systematic review was undertaken to identify those studies where L. rhamnosus was used (either solely or in conjunction with other probiotics). The following databases were searched from the year 2000 through December 8, 2021: PubMed, Cochrane Reviews and Cochrane Central Database of Controlled Trials; systematic reviews were hand searched to identify randomized controlled trials (RCTs). Meta-analytic statistical techniques were then employed. Evaluation of the incidence of atopic eczema was also examined longitudinally based on timeframe. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessments were employed to determine the quality of the evidence.ResultsEleven randomized controlled trials were identified which examined L. rhamnosus in its effect on atopy. Risk of bias was low on the majority of the domains assessed. Meta-analysis of the timeframes ≤ 2 years (RR 0.60, 95% CI 0.47–0.75; p < 0.00001) and 6–7 years (RR 0.62, 95% CI 0.50–0.75; p < 0.00001) demonstrated statistically significant reductions in atopic eczema with use of L. rhamnosus. For the 4 to 5-year (RR 0.74, 95% CI 0.55–1.00; p = 0.05) and 10–11-year (RR 0.68, 95% CI 0.37–1.27; p = 0.23) timeframes there was no statistically significant reduction. GRADE assessment for each timeframe was considered moderate in two, owing to high attrition rates in all of the studies, and low in two due to imprecision.ConclusionBased on the meta-analysis and GRADE assessments, the use of L. rhamnosus with or without other probiotics appears to have a positive effect in reducing the incidence of atopic eczema in pediatric patients at least out to 7 years. Attrition rates temper these findings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40257-022-00723-x.

The abundance of Ruminococcus bromii is associated with faecal butyrate levels and atopic dermatitis in infancy.

Impaired microbial development and decreased levels of short chain fatty acids, particularly butyrate, is suggested to have a role in the development of atopic dermatitis (AD). Faecal microbiota composition, abundance of selected bacterial groups and fermentation metabolites were compared at 90, 180 and 360 days of life between 27 children who developed AD by age one (AD group), and 39 controls (non-AD group) among the CARE (Childhood AlleRgy, nutrition and Environment) study cohort. Diversity within the Firmicutes and Bacteroidetes phylum in the faecal microbiota was lower in the AD group compared to the non-AD group. Longitudinal analysis showed multiple amplicon sequence variants (ASV) within the same bacterial family to be differentially abundant. Namely, Ruminococcus bromii, a keystone primary starch degrader, and Akkermansia muciniphila, a mucin-utilizer, had lower abundance among the AD group. Children with AD were less likely to have high levels of faecal butyrate at 360 days compared to those without AD (11.5% vs 34.2%). At 360 days, children with high abundance of R. bromii had higher level of butyrate as well as lower proportion of children with AD compared to children with low abundance of R. bromii (11.1-12.5% vs 44.4-52.5%), which was independent of the abundance of the major butyrate producers. Our results suggested that R. bromii and other primary degraders might play an important role in the differences in microbial cross-feeding and metabolite formation between children with and without AD, which may influence the risk of developing the disease.

Prize‐winning abstracts from BSACI/WAO 2022 meeting

Prize‐winning abstracts from <scp>BSACI</scp>/<scp>WAO</scp> 2022 meeting

ANALYSIS OF RISK FACTORS ATTENISTIC DERMATITIS ATTENDANCE ON THE CENTER IN PUSKESMAS PAUH PADANG

&#x0D; This study discusses the analysis of risk factors of atopic dermatitis occurrence in infants due to the high incidence rate of atopic dermatitis in infants. The purpose of this study was to determine what factors are at risk of incidence of atopic dermatitis in infants. This type of research is quantitative with case control study. The study was conducted from February to July 2017 with samples for 75 cases and control of 75 people (1: 1) so that the overall sample was 150 people. This research was conducted through interview using questionnaire. Result on Chi-Square was obtained p = 0.000 (p &lt;0.05), where there was significant relationship between genetic, allergen, environment and hygiene with occurrence of atopic dermatitis in infants. Health workers can provide counseling to underfive mothers in Puskesmas Padang Puskesmas work area to be able to pay attention to food given to toddlers and to suppress incidence of atopic dermatitis in under fives. Health workers can increase the knowledge, awareness and willingness of the community about PHBS so as to reduce the incidence rate of atopic dermatitis. Maternal care in paying attention to the food in toddlers can reduce the incidence rate of atopic dermatitis in infants.&#x0D;

Subjective Evaluation Using Patient-Oriented Eczema Measure of the Clinical Effects of 1-Kestose on Atopic Dermatitis in Children: A Pilot Study

Several objective evaluation methods are used to evaluate treatment outcomes in atopic dermatitis clinical trials. We previously demonstrated the clinical efficacy of 1-kestose, the smallest fructooligosaccharide, in the treatment of atopic dermatitis in infants using an objective evaluation method. The utility of the Patient-Oriented Eczema Measure, in which patients themselves or their guardians evaluate the pathophysiology of atopic dermatitis, has recently been reported. In the present study, we used the Patient-Oriented Eczema Measure to confirm the efficiency of the clinical effect of 1-kestose on pediatric atopic dermatitis. An open pilot study was conducted on 22 children with atopic dermatitis. Subjects were orally administered 2 g of 1-kestose daily for 12 weeks and the symptoms of atopic dermatitis were evaluated using the Patient-Oriented Eczema Measure. The median total score of the Patient-Oriented Eczema Measure was significantly decreased by the 1-kestose treatment from 14.2 to 7.7 (P &lt; 0.001). There was no correlation between decreases in the total score of the Patient-Oriented Eczema Measure and the age of subjects. Although the present study was a small pilot study, results suggest that 1-kestose may have attenuated atopic dermatitis to a degree that the patients themselves could recognize.

Understanding immunological origins of atopic dermatitis through multi-omic analysis.

The pathophysiology of atopic dermatitis (AD) is multifactorial, impacted by individual medical, demographic, environmental, and immunologic factors. This study used multi-omic analyses to assess how host and microbial factors could contribute to infant AD development. This longitudinal cohort study included 129 term infants, identified as AD (n=37) or non-AD (n=92) using the Infant Feeding Practices-II survey and review of medical records. Standardized surveys were used to assess medical and demographic traits (gestational age, sex, race, maternal AD, and atopy family history), and environmental exposures (delivery method, maternal tobacco use, pets, breastfeeding duration, and timing of solid food introduction). Saliva was collected at 6months for multi-omic assessment of cytokines, microRNAs, mRNAs, and the microbiome. The contribution of each factor to AD status was assessed with logistic regression. Medical, demographic, and environmental factors did not differ between AD and non-AD infants. Five "omic" factors (IL-8/IL-6, miR-375-3p, miR-21-5p, bacterial diversity, and Proteobacteria) differed between groups (p < .05). The severity of AD was positively associated with levels of miR-375-3p (R=.17, p=.049) and Proteobacteria (R=.22, p=.011), and negatively associated with levels of miR-21-5p (R=.20, p=.022). Multi-omic features accounted for 17% of variance between groups, significantly improving an AD risk model employing medical, demographic, and environmental factors (X2 =32.47, p=.006). Interactions between the microbiome and host signaling may predispose certain infants to AD by promoting a pro-inflammatory environment.

Gut Microbiome Characteristics in Mothers and Infants According to the Presence of Atopic Dermatitis.

Objective The role of the gut microbiome in the onset and development of atopic dermatitis (AD) has been postulated. Thus, we investigated the gut microbial compositions in infants with and without AD and compared the gut bacterial flora of their mothers. Methods The prospective and cross-sectional study participated in 44 pairs of mothers and children. We selected infants born via full-term normal vaginal delivery and no history of antibiotic or probiotic use and infection during the first three months of life. The 15 pairs, consisting of nine healthy infants and six AD infants, were included in this study. Fecal samples of mothers and infants were analyzed within 30 days of delivery and at 12 months, respectively. Microbes in the fecal samples of mothers and infants were subjected to analysis of 16S rRNA amplicon sequencing. Results The abundance of specific taxonomic groups was notably different, but microbial diversity and phylogenetic distances were not significantly different in either maternal or infant groups according to the presence of infant AD. A total of 12 species were selected as differential species in infants with AD compared to healthy infants. Six species were significantly different in the mothers of infants with AD compared to the mothers of healthy infants. Akkermansia muciniphila was only detected in healthy infants and their mothers. Conclusion The presence of Akkermansia muciniphila in mothers and children after vaginal delivery is associated with the onset and development of AD.

Vitamin D deficiency in young children. The realities of today

The article presents a review of the literature on the clinical aspects of assessing vitamin D deficiency in young children by the concentration of 25(OH)D (hydroxycalciferol) in blood serum. The purpose of the review was to familiarize pediatric specialists with the real state of affairs in assessing the clinical significance of diagnosing vitamin D status, its relationship with the prevention of deficient rickets, ways of correcting and choosing the dose of calciferol. A daily dose of 400 IU of vitamin D for young children is effective and safe in preventing deficient rickets. Higher subsidized doses of calciferol have not been shown to be more effective. In addition, they can potentially lead to toxic levels of vitamin D metabolites in the blood. When using lower daily doses (less than 400 IU), an adequate prophylactic effect may not be achieved. Determination of the level of circulating serum hydroxycalciferol, which characterizes the status of vitamin D in the body, is not recommended for routine examination and as a standard for diagnosing deficient rickets in young children. Calciferol has multilateral effects, modulates not only phosphorus-calcium metabolism, but also affects other systems and functions of the body, in particular, ontogenesis and the immune system. According to foreign literature, all infants should receive vitamin D for the prevention of rickets, treatment from the age of one month. This is most reliably identified for children, probably at risk. Convincing data indicating a positive protective effect on diabetes mellitus D on unforeseen pathology, for example, the frequency of exclusion of pneumonia, infectious diarrhea, atopic dermatitis in infancy, has not yet been obtained.

The Impact of Prenatal Nutrition on the Development of Atopic Dermatitis in Infancy and Childhood.

Atopic dermatitis (AD) is an inflammatory skin condition characterized by skin barrier disruption and inflammation that has been associated with the development of food allergies, asthma, and allergic rhinitis, known as the atopic march. The prevalence of AD has been increasing globally, with a marked increase in developed countries. Although many studies have examined environmental factors contributing to the development of AD in infancy and childhood, less is understood about the influence of prenatal factors. Several studies have examined the role of maternal diet and nutrition on the development of AD in offspring; however, formal recommendations and robust trial data are lacking. Herein, we examine the existing literature surrounding maternal diet on the development of AD in infancy and childhood.

Hypopigmented patches in a child

A 7-year-old boy is being evaluated for asymptomatic white spots of 2 years' duration. He has no triggers or preceding skin lesions. He denies any medication use or current medical issues. His medical history is significant for atopic dermatitis in infancy. Review of systems has negative findings.

Viral wheezing in early childhood as a risk factor for asthma in young adulthood: A prospective long-term cohort study.

Background and AimsThere is an increased risk of asthma after viral wheezing episodes in early childhood, but unfortunately, prospective longitudinal data until adulthood are mostly lacking. The aim of this cohort study was to evaluate the risk of asthma in young adulthood after hospitalization for viral wheezing episodes in early childhood.MethodsThe original cohort comprised 100 individuals aged <24 months who were hospitalized for viral wheezing episodes in 1992–1993. After the index episode, data on a diagnosis of asthma 1 year later and at median ages of 4.0, 7.2, and 12.3 years were recorded in follow‐up visits. Forty‐nine individuals attended the latest follow‐up visit at the age of 17–20 years. Current asthma was diagnosed based on symptoms at the time of the last follow‐up, use of inhaled corticosteroids and peak expiratory flow monitoring.ResultsA total of 26 (53%) of the 49 cohort individuals had asthma at a mean age of 18.8 years. In multivariate analyses, a diagnosis of asthma 1 year after index hospitalization and at ages 4.0, 7.2, and 12.3 years were significant risk factors for current asthma (adjusted odds ratios [aORs] of 7.13, 8.86, 8.05, and 21.16, respectively). Atopic dermatitis in infancy (aOR: 4.20) and eosinophilia on admission (5.18) were also significant predictive factors for asthma.ConclusionOver half (26/49) of the participants who had been hospitalized for viral wheezing episodes in early childhood had asthma in young adulthood. An asthma diagnosis at any age during childhood, as well as eosinophilia in early childhood, were independent significant predictive factors for asthma.

Effectiveness of Pediatric Teleconsultation to Prevent Skin Conditions in Infants and Reduce Parenting Stress in Mothers: Randomized Controlled Trial.

BackgroundIn Japan, eHealth for infants and mothers is currently an important aspect, but its effectiveness has rarely been examined. For infants, skin problems, including atopic dermatitis (AD), which is known to lead to other allergic diseases, are one of the most common conditions. Mothers of infants are prone to experiencing parenting stress, which adversely affects mothers’ and children’s well-being. Additionally, studies have reported that AD among offspring enhances parenting stress, and postnatal maternal psychological problems can increase the risk of AD in children.ObjectiveThis study evaluated the effectiveness of pediatric teleconsultation for preventing AD in infants and reducing parenting stress in mothers in Japan.MethodsThe study was an open-label, randomized, parallel-armed controlled trial. In total, 318 pairs of infants and mothers in the Yokohama City Sakae Ward were recruited when they submitted birth cards to the ward, received the explanation about the trial, and provided informed consent on the website for this trial. Eligible pairs of infants and mothers were randomly assigned to the intervention group (n=140) or the control group (n=138). Participants in the intervention and control groups received routine postnatal care from local government services. In addition, participants in the intervention group had the option to combine routine pediatric services with teleconsultation and email newsletters without charge from the date of registration until the infant turned 4 months. Primary outcomes were (1) the prevalence of AD in infants diagnosed based on the United Kingdom Working Party criteria and (2) parenting stress and mental status of mothers assessed using the Parenting Stress Index-Short Form (PSI-SF) and General Health Questionnaire-12 (GHQ-12). Data were collected by the ward office staff and researcher during the 4-month checkup.ResultsThe prevalence of AD in infants was significantly lower in the intervention group than in the control group during the 4-month checkup (20% vs 33%, P=.02; relative risk ratio, 0.709 [95% CI 0.519-0.969]). No significant differences were observed in the PSI-SF and GHQ-12 scores between the 2 groups. There was a significant difference in the prevalence of AD between participants who used teleconsultation services and email newsletters, participants who did not use teleconsultation services but received email newsletters, and participants who neither received nor used either service (18% vs 22% vs 33%, P=.048).ConclusionsThis is the first randomized controlled trial demonstrating that routine pediatric care combined with teleconsultation and email newsletters was effective in reducing the prevalence of AD in infants. The findings highlight the potential of pediatric eHealth to become a useful new strategy for preventing AD.Trial RegistrationUniversity Hospital Medical Information Network Clinical Trials Registry UMIN000029774; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034022

Genetic polymorphism of ADAM17 and decreased bilirubin levels are associated with allergic march in the Korean population

BackgroundThe “allergic march” refers to changes in the frequency and intensity of allergic diseases with age. Classically, the allergic march begins with atopic dermatitis in infancy and leads to asthma and rhinitis as it continues. There are many factors that induce the allergic march; however, TNF-α may play an important role in inducing inflammation. Therefore, the therapeutic potential of TNF alpha-targeting agents is being considered for allergic march treatment.MethodsWe performed a correlation study to determine whether genetic polymorphisms of ADAM17 and clinical serum values between allergic and normal groups affect disease development by using the cohort data of the Korean genome epidemiologic research project. Gene association study was performed using PLINK version 1.07 (http://pngu.mgh.harvard.edu/–purcell/plink) and other statistical analysis was performed using PASW Statistics (version 18.0, SPSS Inc. Chicago, IL, USA).ResultsADAM17 (also called TNF-α converting enzyme or TACE) showed a statistically significant association with the allergic march. The 13 and 8 SNPs in ADAM17 were significantly associated with asthma and allergies, respectively. Among them, on average, SNP of rs6432011 showed the greatest statistical correlation with asthma (P = 0.00041, OR = 1.95, 95% CI 1.35–2.82) and allergies (P = 0.02918, OR = 1.35, 95% CI 1.03–1.78). The effect of SNPs in ADAM17 on transcription factor binding was confirmed using RegulomeDB. The six SNPs are located in the genomic expression quantitative trait loci (eQTL) region and can affect transcription factor binding and gene expression. In clinical serum analysis, bilirubin levels were significantly decreased in the allergic group. The multivariate logistic regression analysis revealed that the low-bilirubin groups indicated a 3.22-fold increase in the prevalence of asthma compared with the high-bilirubin group.ConclusionsThe ADAM17 gene and low bilirubin levels are associated with the allergic march in the Korean population, which can provide new guidelines for managing this disease progression phenomena.

The relationship between serum 25（OH）D level, food allergy and the severity of atopic dermatitis in infants

The relationship between serum 25（OH）D level, food allergy and the severity of atopic dermatitis in infants

Lower caprylate and acetate levels in the breast milk is associated with atopic dermatitis in infancy.

Atopic dermatitis (AD) occurs in exclusively breastfed infants. As fatty acids have some immunomodulatory effect, we aimed to investigate the influence of fatty acid compositions in breast milk (BM) on the development of AD in exclusively breastfed infants. We enrolled two- to four-month-old exclusively breastfed infants. The objective SCORing Atopic Dermatitis (objSCORAD) was evaluated. The lipid layer of BM was analyzed by gas chromatography for fatty acid levels. Medical charts were reviewed. Forty-seven AD infants and 47healthy controls were enrolled. The objSCORAD was 20.5±1.7 (shown as mean±SEM) in the AD group. The age, sex, parental atopy history, and nutrient intake of mothers were not significantly different between two groups. The palmitate and monounsaturated fatty acid (MUFA) levels in BM positively correlated with objSCORAD, while caprylate, acetate, and short-chain fatty acid (SCFA) levels negatively correlated with objSCORAD (p=.031, .019, .039, .013, .022, respectively). However, the butyrate levels in BM were not significantly different. The caprylate and acetate levels in BM were significantly associated with the presence of infantile AD (p=.021 and .015, respectively) after adjusting for age, sex, parental allergy history, MUFA, palmitate, and SCFA levels in BM. ObjSCORAD in infancy was significantly associated with persistent AD (p=.026) after adjusting for age, sex, parental atopy history, caprylate, palmitate, MUFA, acetate, and SCFA levels in BM. Caprylate and acetate levels in BM for exclusively breastfed infants were negatively associated with objSCORAD. Lower caprylate and acetate in BM might be the risk factors for infantile AD, while butyrate in BM was not associated with infantile AD.

Early-life infections in association with the development of atopic dermatitis in infancy and early childhood: a nationwide nested case-control study.

Microbial dysbiosis has been implicated in the development of atopic dermatitis (AD). The risk of development of AD following early-life infections remains unclear. To investigate the impact of early-life infections on AD development. This population-based nested case-control study was conducted using the Taiwan's National Health Insurance Research Database. A total of 5454 AD patients and 16 362 control subjects without AD were identified, for the period 1997 to 2013. Demographic characteristics, comorbidities and maternal factors were compared. Adjusted odds ratio (aOR) was calculated to examine the associations between early-life infections and subsequent AD by conditional stepwise logistic regression analysis. Mean age was 2.6 ± 2.9 years in both groups. Overall infections (41.8% vs. 28.9%) before the diagnosis of AD were more common in AD patients than in control subjects (P < 0.001). Infectious diseases [aOR, 1.40; 95% confidence interval (CI), 1.29-1.51], skin infections (aOR, 1.55; 95% CI, 1.40-1.71) and systemic antibiotic exposure (aOR 1.67, 95% CI 1.55-1.79) before AD diagnosis were independently associated with AD development on multivariate analyses. These results were consistent across observation periods (0-1, 1-2 and >2 years after birth) and sensitivity analyses after redefining the index date as 3 or 6 months before the date of AD diagnosis. Other independent risk factors included asthma, allergic rhinitis, intussusception and neonatal hyperbilirubinemia. No association with subsequent AD was found for maternal age at delivery, Caesarean delivery or prenatal antibiotic exposure. Infections in early life are associated with AD development in infancy and early childhood.

Diagnosing atopic dermatitis in infancy using established diagnostic criteria: a cohort study.

Diagnosing atopic dermatitis (AD) in infants is challenging. To determine the incidence and persistence of eczema and AD in infants using the UK Working Party (UKWP) and Hanifin and Rajka (H&R) criteria. A cohort of 1834 infants was examined clinically at 3, 6 and 12 months of age. AD was diagnosed by UKWP (3, 6 and 12 months) and H&R (12 months) criteria. Logistic regression models were used to assess the relationship between AD and eczema. Eczema was observed in 628 (34·2%) infants (n = 240, n = 359 and n = 329 at 3, 6 and 12 months, respectively), with AD diagnosed in 212 (33·7%) infants with any eczema and in 64/78 (82%) infants with eczema at all three visits. The odds of AD were lower with first presentation of eczema at 6 [odds ratio (OR) 0·33, 95% confidence interval (CI) 0·22-0·48] or 12 months (OR 0·49, 95% CI 0·32-0·74) than at 3 months, and higher in infants with eczema at three (OR 23·1, 95% CI 12·3-43·6) or two (OR 6·5, 95% CI 4·3-9·9) visits vs. one visit only. At 12 months, 156/329 (47·4%) fulfilled the UKWP and/or H&R criteria; 27 (8%) fulfilled the UKWP criteria only and 65 (20%) only the H&R criteria. Of the 129 infants who fulfilled the H&R criteria, 44 (34·1%) did not meet the itch criterion. Used in combination and at multiple timepoints, the UKWP and H&R criteria for AD may be useful in clinical research but may have limited value in most other clinical settings.

Diagnosing atopic dermatitis in the first year of life

Abstract Linked Article: Endre et al. Br J Dermatol 2022; 186:50–58. Atopic dermatitis is a common skin disease, often starting in the first year of life. However, the disease may be difficult to diagnose during infancy, even when using well-defined diagnostic criteria. Atopic dermatitis is also known as atopic eczema. The two terms are often used interchangeably in daily clinical practice, although eczema used alone is usually considered to be a more general term. In children, a diagnosis of atopic dermatitis is thought to mean a worse outcome compared with a diagnosis of eczema. In this study, we report the occurrence of eczema in over 1800 infants in Norway and Sweden at 3, 6 and 12 months of age, and how many of these would fulfil two widely used diagnostic criteria for atopic dermatitis called the UK Working Party criteria and the Hanifin &amp; Rajka’s criteria. Approximately one-third of all the infants had eczema at some point. However, only about one-third of these infants fulfilled either of the two sets of diagnostic criteria for atopic dermatitis. Those who already had eczema at 3 months and those with eczema at more than one visit were most likely to fulfil the criteria. More infants were diagnosed with atopic dermatitis by the Hanifin &amp; Rajka’s criteria than the UK Working Party criteria at 12 months. We found that a diagnosis of atopic dermatitis is hard to confirm in infancy. We recommend repeated examinations and using both sets of diagnostic criteria when diagnosing atopic dermatitis in infants. This approach may be relevant for research studies, but not so much in a busy clinical practice. The term infantile eczema may be more appropriate to use until the characteristics of atopic dermatitis have become clearer after infancy. Linked Article: Endre et al. Br J Dermatol 2022; 186:50–58.