Atopic dermatitis in children and adolescents

Atopic dermatitis is a chronic and complex pruritic inflammatory skin disease, common among children. There is a consistent association of atopic dermatitis with other atopic and allergic conditions including food allergy, asthma, atopic rhinitis and conjunctivitis, in a progression known as the atopic march. The impact on quality of life is significant and underestimated. Therefore, atopic dermatitis is not enough treated. Beliefs of patients, family and health care professionals decrease the compliance and encourage medical nomadism. Comprehensive care of the patient includes structured therapeutic education and need to be planned. Compounding factors such as food allergy, superinfection, psychological disturbance, allergic contact dermatitis must be taken into account. Infants with severe atopic dermatitis which are resistant to a well-conducted local treatment should be checked for food allergy. A treatment plan needs to be negotiated with the patient, age-adjusted, according to the severity of atopic dermatitis. The disease severity is mainly assessed by scores based on objective and subjective symptoms. Treatment of the flares is as important as long-term control. This needs to be clearly explained to the patient. Topical corticosteroids are important and effective anti-inflammatory drugs to be used in atopic dermatitis flares and have been successfully tested with a proactive approach to treating atopic dermatitis on long-term control basis. Vehicle and strength of topical corticosteroids is adapted on the invidual basis. Topical Tacrolimus is a second line drug treatment and can be use in the same way of topical corticosteroids during flares and remission after 2 years old. This drug is more efficient on the face and folds. Dupilumab is the first biologic to be used in atopic dermatitis with a good efficacy and an acceptable safety profile. Its use is for now restricted to adolescents and adults. (C) 2020 Elsevier Masson SAS. All rights reserved.