Management Of Pediatric Atopic Dermatitis Research Articles

Improving pediatric atopic dermatitis care in the emergency department and primary care setting: a collaborative quality improvement pilot project.

Emergency department visits and healthcare expenditures for pediatric atopic dermatitis have been increasing over the last two decades. There is a paucity of replicable quality improvement initiatives addressed at educating primary care and emergency medicine clinicians on this condition. The goal of this initiative was to improve clinician knowledge and comfort in the diagnosis and management of pediatric atopic dermatitis and superinfection. Clinicians were recruited via email from academic and community settings in Travis County, Texas, in 2020. They were sent a pre-intervention survey, a series of three quizzes, and a post-intervention survey. After each quiz, participants received performance feedback and various forms of multimodal education. Differences between the first and final quiz scores and clinician confidence levels were analyzed for statistical significance. Fifty-six clinicians completed the intervention. The average overall and treatment-specific scores increased significantly by 10% and 37%, respectively. Further, confidence levels improved significantly in the majority of clinicians. Clinician qualitative feedback revealed high satisfaction. Results from this educational quality improvement project have demonstrated that this is an effective and replicable resource for educating clinicians who manage pediatric atopic dermatitis in the emergency department and outpatient setting.

Naturopathic approach towards pediatric atopic dermatitis: A case report

A 75-day-old male infant presented to the Naturopathy and Yoga Hospital by his mother with complaints of a dry, scaly, and itchy scalp, dry skin, and crying while passing stools for a month. He was diagnosed with atopic dermatitis (AD) using the Hanifin–Rajka criteria. The infant has been administered two topical applications on the entire body for ten days using Epsom salt (5 g) (magnesium sulfate) mixed with Aloe vera (15 g), turmeric powder (about 0.6 g) in warm coconut oil. Modifications in the mother’s diet were also advised. The case report shows remarkable changes in the symptoms with a reduction in the scaly patches on the scalp and rashes over the body. Following ten days of intervention, the baby stopped crying while passing stools. On follow-up, 30 days after the discharge, no relapses were reported, and the child was healthy. This case report shows the simple topical application of Epsom salt, coconut oil, Aloe vera, and turmeric combinations in the management of pediatric AD, inferring that, naturopathy interventions can be safe, and cost-effective in managing the AD in infants. However, further large-scale studies are warranted in this area for establishing safety, and efficacy and for large-scale applications in pediatric cases.

Is corticophobia spreading among pediatricians?-Insights from a self-efficacy survey on the management of pediatric atopic dermatitis.

Atopic dermatitis (AD) is a chronic dermatological condition, often diagnosed and managed by pediatricians. However, pediatricians have difficulties with adhering to guidelines, which recommend the use of topical corticosteroids (TCS) as a first-line treatment and oral corticosteroids (OCS) for resistant cases. Our aim was to assess pediatricians' self-confidence in using steroids in the management of pediatric AD, and investigate which characteristics are related to high self-confidence in prescribing corticosteroids (CS). We conducted a cross-sectional questionnaire study among Israeli pediatricians between April 2022 and June 2022. Participants were asked to answer questions dealing with self-assessment of prescribing CS in the management of AD. A total of 171 residents and pediatricians participated in the survey; 86.6% and 28.1% admitted feeling either average or below-average confidence in the prescription of OCS and TCS, respectively. Physicians who were exposed to higher AD patients (P=0.048) and worked at the clinics (88.2% vs. 60.4%, P<0.001) had high self-confidence in treating AD with TCS. Males (20.3% vs. 8%, P=0.03), and having gone to medical school outside Israel (22.2% vs. 10.4%, P=0.09) were all related to high self-efficacy in prescribing OCS. In total, 11.7% of participants confessed to refraining from prescribing steroids because of fear of side effects. Most pediatricians have below-average confidence in prescribing OCS for the treatment of AD. Males, working in a community setting, and previous exposure improve the confidence level and can be easily considered in future pediatric training programs.

41385 Investigating efficacy of PDE-4 inhibitors in reducing topical steroid use for management of pediatric atopic dermatitis: A double-blind randomized control study

41385 Investigating efficacy of PDE-4 inhibitors in reducing topical steroid use for management of pediatric atopic dermatitis: A double-blind randomized control study

Unmet Medical Needs and Early Referral of Pediatric Atopic Dermatitis: An Expert Modified Delphi Consensus from Saudi Arabia

Atopic dermatitis (AD) is a chronic skin disease with increasing prevalence worldwide. It is characterized by pruritic eczematous lesions, affecting up to 20% of the children and negatively impacting their quality of life. Guidelines for AD management are available worldwide, but specific guidelines for pediatric AD in Saudi Arabia are lacking. This consensus document aims to identify the needs for the diagnosis and management of pediatric AD in Saudi Arabia by gathering the opinions and recommendations of key experts. We conducted a three-step modified Delphi method to develop the present consensus. The experts agreed that pediatricians and dermatologists commonly encounter AD; however, it is still under-recognized in its early stage in Saudi Arabia. The family physicians should be involved in assessing suspected children with a family history of atopy, particularly in patients with isolated lesions. Further, the experts confirmed that AD diagnosis should be documented, showing assessment criteria used, key morphological characteristics, and features used to ascertain the severity of the disease. There is still a need for simple validated diagnostic criteria suitable for daily practice for pediatric AD. The experts highlighted several medical conditions that pertain to the diagnosis and management of AD in Saudi Arabia.

Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis: Consensus statement of the Taiwan Academy of Pediatric Allergy, Asthma and Immunology

Atopic dermatitis (also known as atopic eczema) is a chronic relapsing inflammatory skin disease commonly seen in children, with increasing prevalence over the past few decades in many countries including Taiwan. The management of pediatric atopic dermatitis can be challenging, particularly as treatment options are expanding with the emergence of novel systemic and topical anti-inflammatory medications in recent years. The Taiwan Academy of Pediatric Allergy, Asthma and Immunology (TAPAAI) has developed the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis, which provides a concise overview of its epidemiology, clinical characteristics and diagnosis, mechanisms, treatments, and education. The contents of this guideline integrate the principles of recent national and international guidelines for the diagnosis and management of atopic dermatitis, latest research findings, and expert opinions of experienced pediatric allergy specialists in Taiwan. For practical purposes, this guideline presents simplified and easy-to-use diagnostic criteria and severity grading for pediatric atopic dermatitis. A stepwise treatment algorithm is also proposed to expedite rational, cost-effective, and evidence-based management strategy. This guideline, developed based on current best evidence and real-world experience of pediatric allergy experts in Taiwan, is intended to facilitate practical, up-to-date management of pediatric atopic dermatitis among physicians.

Review of the holistic management of pediatric atopic dermatitis.

Patient quality-of-life can be negatively affected by the symptoms, expense, stigma, and time commitment, andinconvenience imposed by complicated treatment regimens. To ensure proper, holistic management of pediatricAD, multiple factors must be considered; seasonal changes, lifestyle modifications, and the psychosocial impactare just a couple of factors that require monitoring. • Atopic dermatitis impacts patients and their families in quality of life, economically, and psychosocially. • Current treatment revolves largely around treating physical manifestation of disease with first line measures such as topical steroids. • The holistic management of AD incorporates a good physician-patient relationship, frequent follow-up, and providing structured written plans. • We introduce the house building model for improving treatment adherence. Pediatric AD can be managed in a more holistic manner which incorporates several factors from the lives of patients and their families. Pediatric patients suffer from many physical and mental comorbidities which should be screened for. Adherence with treatment may be improved by following a model which emphasizes establishing a good physician-patient relationship, frequent follow-up, and providing structured written plans.

Management of Pediatric Atopic Dermatitis by Primary Care Providers: A Systematic Review

Primary care providers (PCPs), including pediatricians and general practitioners, are often the first to see children with eczema/atopic dermatitis (AD). Little is known about management of pediatric AD by PCPs and adherence to national guidelines. To review existing literature examining management components of pediatric AD (topical corticosteroids [TCS], topical calcineurin inhibitors [TCIs], antihistamines, bathing, emollients, and diet) by PCPs. PubMed/Medline and Embase. English-language articles dated 2015 to 2020 reporting outcomes addressing management of pediatric AD by PCPs. Two authors independently screened titles/abstracts, reviewed full-text articles, extracted relevant data, and evaluated study quality. Disagreements were resolved by a third author. Twenty articles were included. Surveys and national database analyses were the most common methodologies (n=7 each). PCPs commonly prescribed TCS but had a preference for low-potency agents, overprescribed nonsedating antihistamines, and avoided TCIs. PCPs commonly recommended emollients, although this was not universal. Data characterizing nonmedication management were limited. Most studies did not examine individual patient encounters, but rather relied on providers reporting their general behaviors. Provider behavior may vary based on country of practice. Knowledge and management gaps exist among PCPs in treating pediatric AD in key areas including knowledge of TCS safety profiles and prescribing of TCIs. The current literature is largely limited to small studies that evaluate prescribing behaviors with limited data characterizing nonmedication management, highlighting the need for future research in this area.

Topical therapy for atopic dermatitis: A review

Background: Pediatric atopic dermatitis(AD) is very common, but its management is frustrating for the dermatologist, child and parents alike as this chronic inflammatory skin disease is marked with numerous difficult to control flares. Although country specific guidelines for AD exist, there is paucity of data with respect to dedicated topical care regimens for AD management in pediatric population. Purpose: This is a broad based review exploring various topical practices and management options to manage pediatric AD during flares and in remissions. Scope: The PubMed database was searched (to 1 June 2020) for English-language articles containing the keywords atopic dermatitis, atopic eczema, topical calcineurin inhibitor(TCI), topical corticosteroid(TCS), topical phosphodiesterase inhibitors, crisaborole, topical therapy. Articles focusing on topical managment for children with AD were chosen for further review. A limitation is that this is not a systematic review of the literature. We have relied heavily on The Indian Dermatology Expert Board Members 2019 Management Guidelines on AD and the 2014 American Academy of Dermatology (AAD) guidelines, soon to be updated. In our review, we focus on Skin directed therapies to repair and maintain healthy skin barrier, suppress inflammatory response, control flares, control itch and manage infectious triggers. Topicals can be used as first line therapy in mild AD, adjuvant for moderate-severe AD or as maintenance to keep the disease in remission. Topical therapy in AD is not limited to TCS, TCI, Crisaborole or newer molecules but also involves moisturization, emollient care and bathing practices; which have been discussed. Conclusion: Multiple topical therapies and practices have been successfully used to treat children with AD. An understanding of the available treatment options will help dermatologists striving to achieve best practice in the management of pediatric AD.

Update on management of pediatric atopic dermatitis

Atopic dermatitis is the most common chronic inflammatory skin disease in children. It usually develops in infancy and early child hood and is an entry point of ‘atopic march’, which may progress to other allergic diseases, including allergic rhinitis and asthma. Al though there is no disagreement on the importance of early treatment of atopic dermatitis, it is difficult to treat children with mod erate to severe atopic dermatitis due to concerns about treatment-related side effects and age restrictions for effective drugs in real world. As recent researches have extend our understanding of pathogenesis, new agents targeted key pathologic mechanisms have been developed. Therefore, it is time to establish a new paradigm of treatment for children with atopic dermatitis since new biologics have been demonstrated to be effective and safe in children. The objective of this article is to review the clinical character istics, severity classification, pathogenesis, and treatment, in particular, biologics already approved/undergoing clinical trials for chil dren with atopic dermatitis. (Allergy Asthma Respir Dis 2021;9:59-68)

Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis.

This document is intended to provide practical guidance to physicians treating pediatric atopic dermatitis (AD), especially dermatologists, pediatricians, allergists, and other health-care professionals. The recommendations contained here were formalized based on a consensus of 12 Canadian pediatric dermatologists, dermatologists, pediatricians, and pediatric allergists with extensive experience managing AD in the pediatric population. A modified Delphi process was adopted with iterative voting on a 5-point Likert scale, with a prespecified agreement cutoff of 75%. Topic areas addressed in the 17 consensus statements reflect areas of practical management, including counselling, assessment, comorbidity management, and therapy.

Impact of pharmacists' counseling on caregiver's knowledge in the management of pediatric atopic dermatitis.

Atopic dermatitis (AD) is a common skin condition in childhood. AD management can be complex, and caregivers may have inadequate information on the disease, aggravating factors, and management. Comprehensive therapeutic education has been closely associated with increased compliance and is recommended for all patients. There are, as yet, no studies on the impact of a pharmacist-led eczema counseling service. The primary objective was to assess the impact of a pharmacist-led eczema counseling service on improving caregivers' knowledge. The secondary objective was to evaluate caregivers' satisfaction of the service and their confidence in handling the patient's condition after counseling. This was a prospective, questionnaire-based observational study. After obtaining informed consent, caregivers were required to complete questionnaire A, containing items on demographics and knowledge assessment. Caregivers then underwent a counseling session by a dermatology-trained pharmacist. After counseling, caregivers were required to complete questionnaire B containing items on satisfaction and confidence level. A follow-up phone call was conducted after initial counseling session, during which knowledge-based questionnaire C would be completed. Data from 32 participants were included in the analysis. There was a significant improvement in caregivers' knowledge score after receiving counseling, with mean precounseling score of 8.38±3.92 and mean postcounseling score of 13.88±3.65 (P<0.001). Majority was satisfied with the service and was confident in handling their child's condition. Pharmacist-led eczema counseling has a positive impact on caregiver's knowledge and can lead to improved compliance. The service was well received, although more time could be spent during the counseling.

Using the topical moisturizing agent in children whit atopic dermatitis is the cornerstone of the successful preventive treatment

Summary.This article describes the management of pediatric atopic dermatitis (AD) of all severities and covers the use of nonpharmacologic approaches (eg, moisturizers, bathing practices, and wet wraps). Atopic dermatitis is a chronic, pruritic, inflammatory dermatitis that affects up to 25% of children. Xerosis is one of the cardinal clinical features of AD and results from a dysfunctional epidermal barrier. Topical moisturizers are used to combat xerosis and transepidermal water loss, with traditional agents containing different amounts of emollient, occlusive, and/or humectant ingredients. Although they often include water as well, this only delivers a transient effect, whereas the other components provide the main benefits.Moisturizers can be the main primary treatment for mild disease and should be a part of the regimen for moderate and severe disease. They are also an important component of maintenance treatment and prevention of flares. Moisturizers are therefore a cornerstone of AD therapy and should be included in to the management plans especially in children.There are a few systematic studies to define an optimal amount or frequency of application of moisturizers. It is generally thought that liberal and frequent reapplication is necessary to reduce xerosis to minimal. Traditional moisturizers are formulated into a variety of delivery systems, including creams, ointments, oils, gels, and lotions. Although most ointments have the advantage of not containing preservatives, which may cause stinging when applied to inflamed skin, they may be too greasy for some patients with AD. Lotions have a higher water content that can evaporate and may be less ideal in those with significant xerosis.Head-to-head trials between specific moisturizing products are few, and the published information has not demonstrated the preference of one emollient to others. Therefore, the choice of moisturizing agent highly depends on the individual preference. In our clinic we also have a long experience of using emollients in children with AD, including young children. Very often in our practice we use Topicrem, Physiogel and Oilatum. Analyzing efficiency of each, we have identified 24 children aged from 6 months to 2 years with a diagnosis of atopic dermatitis in remission and divided them into three equal groups. Observation period lasted 14 days. Evaluation of efficacy was performed using SCORAD index, determined not only objective criteria but also subjective marks sleep disorders and severity of itching. During the study, accurately clinical observation refers to the third level of evidence (C), we were able to demonstrate again the high efficiency of moisturizers. Analyzing the results, first of all, we want to emphasize the good clinical efficacy of all three emollients.To conclude, the choice of moisturizers demands an individual approach. The ideal agent should be safe, effective, inexpensive, and free of additives, fragrances, perfumes, and other potentially sensitizing agents.

Calcineurin Inhibitors in Pediatric Atopic Dermatitis

Atopic dermatitis (AD) is a common, chronic inflammatory dermatosis with a prevalence of 7-21% in school-aged children. Childhood AD has a profound impact on the social, personal, emotional, and financial perspectives of families. For the last half-century, topical corticosteroids of different potencies have been the mainstay of topical therapy. In recent years, two topical calcineurin inhibitors (TCIs), tacrolimus and pimecrolimus, have become available for the treatment of AD. Both tacrolimus and pimecrolimus have been extensively evaluated in the management of pediatric AD. Trials comparing them with placebo, topical corticosteroids, and each other have shown them to be effective and safe for continuous short-term use, and for noncontinuous use for up to 4 years. Long-term safety of TCIs is not known as they have been in clinical use for less than a decade.