Atopic Dermatitis in Babies and Toddlers

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Atopic dermatitis (AD) is a form of eczema (also called atopic eczema). AD is a chronic, itchy skin disease that most commonly begins in infants, typically occurring between 3 and 6 months of age. Approximately 60% of cases of AD develop in the first year of life, and 90% develops by 5 years of age.1 AD is caused by a combination of factors, including a genetic predisposition, environmental factors, a dysfunction in the immune system, and a dysfunction of the skin barrier.2,3

There are some differences in AD depending on the age of the person affected. This article will focus on infants and toddlers up to age 2. Children age 2 years and older are also commonly affected by AD. Most children go into remission, although some experience relapses in their teen years and some continue to have symptoms into adulthood. Rarely, AD may begin in adulthood.4

Risk factors

The majority of infants who develop AD have someone in their family with the condition. A child’s chances of developing AD are 2- to 3-fold higher in children who have a parent with AD. If both parents have AD, the child’s chances of developing the skin condition increase to 3- to 5-fold.1

AD is more common in urban areas, and children living in cities are at a higher risk of developing AD. The age of the mother at the child’s birth also seems to increase a child’s risk of AD, with children being born to mothers who are later in their childbearing years being more likely to develop AD.5

Common symptoms

In infants, AD usually appears as a rash on the scalp or face, especially the cheeks or chin. AD makes the skin dry, itchy, and scaly, and there may also be areas that bubble up and ooze fluid. AD ranges in severity from mild to severe. AD causes a significant itch, and scratching can cause sleep disturbances and lead to increased risk of infection.1,2

There are several triggers that can make atopic dermatitis worse, including:

Possible complications

Some infants or toddlers develop complications from AD, including: infections, eye complications, issues with sleeping, and/or food allergies.

Infection

Because AD causes cracks and breaks in the skin and there is immunologic dysregulation of the skin, there is a greater potential for infection. In addition, the intense itching caused by AD leads to scratching, which also increases the risk of infection by bacteria, viruses, or fungi.6

Eye complications

Infants and toddlers with AD are also at risk of developing eye complications, which include itching around the eyes, eye watering, inflammation of the eyelid (blepharitis), and infection (conjunctivitis).7

Sleep problems

Many children with AD wake repeatedly during the night to scratch due to the excessive itchiness. The repeated waking and loss of sleep is one of the most distressing impacts of AD on children living with the condition, as well as their family members.6,7

Food allergies

AD puts children at a higher risk of developing food allergies, with an estimated 20-40% of children with AD having food allergies that worsen their disease. The most common food allergies that worsen AD include cow’s milk, eggs, fish, peanuts, soy, tree nuts, and wheat. Children with food allergies often outgrow their sensitivity, developing a tolerance over time. Even if a person with AD tests positive for food allergies, it does not necessarily mean that all their food allergies are relevant to their AD. Food allergies are true triggers of AD in only a small subset of patients, and experts do not generally recommend food elimination diets solely on the basis of positive food allergy testing.8,9

Treatment options

 

A key part of treating AD in infants and toddlers is rehydrating the skin, including:

  • Lukewarm soaking baths (less than 10-20 minutes)
  • Mild soaps that are fragrance free and with a neutral or low pH
  • Moisturizing skin immediately after bath with an emollient10

For children who have repeated skin infections, adding 2 teaspoons of bleach per gallon of water can reduce the chance of infections, this is known as a bleach bath. (A typical bathtub holds between 25-40 gallons of water.)10 Topical corticosteroids may be prescribed for children with AD whose condition doesn’t respond to good skin care and regular use of emollients.1

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view references
  1. Eichenfield LF, Tom WL, Chamilin SL, et al. Guidelines of care for the management of atopic dermatitis. Journal of the American Academy of Dermatology 2014;70:338- 351.
  2. National Eczema Association. Accessed online on 3/20/17 at https://nationaleczema.org/.
  3. Tollefson MM, Bruckner AL. Atopic dermatitis: skin-directed management. Am Acad Pediatrics. 2014 Dec;134(6):e1735-1744. doi: 10.1542/peds.2014-2812.
  4. Bieber Th. Atopic dermatitis 2.0: from the clinical phenotype to the molecular taxonomy and stratified medicine. Allergy. 2012;67:1475-1482.
  5. American Academy of Dermatology. Accessed online on 3/17/17 at https://www.aad.org/public/diseases/eczema/atopic-dermatitis.
  6. Lyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinical features, pathophysiology, and treatment. Immunol Allergy Clin North Am. 2015;35:161-183.
  7. Mayo Clinic. Accessed online on 4/7/17 at http://www.mayoclinic.org/diseases-conditions/eczema/basics/complications/con-20032073
  8. Peterson JD, Chan LS. A comprehensive management guide for atopic dermatitis. Dermatology Nursing. 2006;18(6):531-542. Accessed online on 4/5/17 at http://www.medscape.com/viewarticle/551352_5.
  9. Sidbury R, et al. Guidelines of care for the management of atopic dermatitis. J Am Acad Dermatol. 2014;71(6):1218-1233.
  10. Medscape. Accessed online on 4/10/17 athttp://emedicine.medscape.com/article/911574-treatment.
View Written By | Review Date
Emily Downward | June 2017
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