Fast Five Quiz: Severe Pediatric Atopic Dermatitis

William D. James, MD


March 15, 2021

The nummular form of atopic dermatitis in childhood differs from that in adults. In adults, the lower limbs are the predilection sites, while in children the lesions additionally develop on the trunk and may be numerous and exudative with vesicles.

Differential diagnosis is more challenging in early childhood than in older children and adults. For example, Netherton syndrome, some congenital immunodeficiency disorders, and generalized peeling skin syndrome share some of the symptoms of atopic dermatitis.

Intrinsic atopic dermatitis is not associated with any allergies, and patients are diagnosed with normal immunoglobulin E levels in the blood and negative skin testing to environmental allergens. This form is more prevalent in infants compared with adults.

Infant skin has fewer natural moisturizing factors and lower surface lipid concentrations but higher water content and higher transepidermal water loss compared with adults. In early childhood, skin pH, desquamation, and proliferation rates are high. This impairs the epidermal barrier structure and function. The infant skin becomes vulnerable to environmental allergens, microbes, irritants, topically applied drugs, and emollients.

Learn more about the differential diagnosis for pediatric atopic dermatitis.


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