Pediatric Atopic Dermatitis Questions & Answers

1. Turner JD, Schwartz RA. Atopic dermatitis. A clinical challenge. Acta Dermatovenerol Alp Panonica Adriat. 2006 Jun. 15(2):59-68. [QxMD MEDLINE Link].

2. Ong PY, Leung DY. Immune dysregulation in atopic dermatitis. Curr Allergy Asthma Rep. 2006 Sep. 6(5):384-9. [QxMD MEDLINE Link].

3. Oranje AP, Devillers AC, Kunz B, et al. Treatment of patients with atopic dermatitis using wet-wrap dressings with diluted steroids and/or emollients. An expert panel's opinion and review of the literature. J Eur Acad Dermatol Venereol. 2006 Nov. 20(10):1277-86. [QxMD MEDLINE Link].

4. Flohr C, Yeo L. Atopic dermatitis and the hygiene hypothesis revisited. Curr Probl Dermatol. 2011. 41:1-34. [QxMD MEDLINE Link].

5. Stelmach I, Bobrowska-Korzeniowska M, Smejda K, Majak P, Jerzynska J, Stelmach W, et al. Risk factors for the development of atopic dermatitis and early wheeze. Allergy Asthma Proc. 2014 Sep. 35(5):382-389. [QxMD MEDLINE Link].

6. Bisgaard H, Halkjaer LB, Hinge R, et al. Risk analysis of early childhood eczema. J Allergy Clin Immunol. 2009 Jun. 123(6):1355-60.e5. [QxMD MEDLINE Link].

7. Leung DY. Our evolving understanding of the functional role of filaggrin in atopic dermatitis. J Allergy Clin Immunol. 2009 Sep. 124(3):494-5. [QxMD MEDLINE Link].

8. Gao PS, Rafaels NM, Hand T, et al. Filaggrin mutations that confer risk of atopic dermatitis confer greater risk for eczema herpeticum. J Allergy Clin Immunol. 2009 Sep. 124(3):507-13, 513.e1-7. [QxMD MEDLINE Link].

9. Kumar R, Ouyang F, Story RE, et al. Gestational diabetes, atopic dermatitis, and allergen sensitization in early childhood. J Allergy Clin Immunol. 2009 Nov. 124(5):1031-8.e1-4. [QxMD MEDLINE Link].

10. Silverberg JI, Kleiman E, Lev-Tov H, et al. Association between obesity and atopic dermatitis in childhood: A case-control study. J Allergy Clin Immunol. 2011 May. 127(5):1180-1186.e1. [QxMD MEDLINE Link].

11. Slomski A. Anti-IgE Medication Lessens Pediatric Atopic Dermatitis Severity. JAMA. 2020 Feb 25. 323 (8):701. [QxMD MEDLINE Link].

12. Alzolibani AA, Al Robaee AA, Al Shobaili HA, Bilal JA, Issa Ahmad M, Bin Saif G. Documentation of vancomycin-resistant Staphylococcus aureus (VRSA) among children with atopic dermatitis in the Qassim region, Saudi Arabia. Acta Dermatovenerol Alp Panonica Adriat. 2012 Sep. 21(3):51-3. [QxMD MEDLINE Link].

13. Silverberg JI, Hanifin J, Simpson EL. Climatic factors are associated with childhood eczema prevalence in US. J Invest Dermatol. 2013 Jan 18. [QxMD MEDLINE Link].

14. Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR,. Is eczema really on the increase worldwide?. J Allergy Clin Immunol. 2008 Apr. 121(4):947-54.e15. [QxMD MEDLINE Link].

15. Ong PY, Boguniewicz M. Atopic dermatitis. Prim Care. 2008 Mar. 35(1):105-17, vii. [QxMD MEDLINE Link].

16. Kvenshagen B, Jacobsen M, Halvorsen R. Atopic dermatitis in premature and term children. Arch Dis Child. 2009 Mar. 94(3):202-5. [QxMD MEDLINE Link].

17. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venreol. 1980. 92:44-7.

18. Mrabet-Dahbi S, Maurer M. Innate immunity in atopic dermatitis. Curr Probl Dermatol. 2011. 41:104-11. [QxMD MEDLINE Link].

19. Lee R, Schwartz RA. Pediatric molluscum contagiosum: reflections on the last challenging poxvirus infection, Part 2. Cutis. 2010 Dec. 86(6):287-92. [QxMD MEDLINE Link].

20. Lee R, Schwartz RA. Pediatric molluscum contagiosum: reflections on the last challenging poxvirus infection, Part 1. Cutis. 2010 Nov. 86(5):230-6. [QxMD MEDLINE Link].

21. Glazenburg EJ, Mulder PG, Oranje AP. A statistical model to predict the reduction of lichenification in atopic dermatitis. Acta Derm Venereol. 2015 Mar. 95 (3):294-7. [QxMD MEDLINE Link].

22. Chopra R, Vakharia PP, Sacotte R, Patel N, Immaneni S, White T, et al. Severity strata for Eczema Area and Severity Index (EASI), modified EASI, Scoring Atopic Dermatitis (SCORAD), objective SCORAD, Atopic Dermatitis Severity Index and body surface area in adolescents and adults with atopic dermatitis. Br J Dermatol. 2017 Nov. 177 (5):1316-1321. [QxMD MEDLINE Link].

23. Schram ME, Spuls PI, Leeflang MM, Lindeboom R, Bos JD, Schmitt J. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy. 2012 Jan. 67 (1):99-106. [QxMD MEDLINE Link].

24. Silverberg JI, Gelfand JM, Margolis DJ, Fonacier L, Boguniewicz M, Schwartz LB, et al. Severity strata for POEM, PO-SCORAD, and DLQI in US adults with atopic dermatitis. Ann Allergy Asthma Immunol. 2018 Oct. 121 (4):464-468.e3. [QxMD MEDLINE Link].

25. Oranje AP. Practical Issues on Interpretation of Scoring Atopic Dermatitis: SCORAD Index, Objective SCORAD, Patient-Oriented SCORAD and Three-Item Severity Score. Curr Probl Dermatol. 2011. 41:149-55. [QxMD MEDLINE Link].

26. van Oosterhout M, Janmohamed SR, Spierings M, Hiddinga J, de Waard-van der Spek FB, Oranje AP. Correlation between Objective SCORAD and Three-Item Severity Score used by physicians and Objective PO-SCORAD used by parents/patients in children with atopic dermatitis. Dermatology. 2015. 230 (2):105-12. [QxMD MEDLINE Link].

27. Perrett KP, Peters RL. Emollients for prevention of atopic dermatitis in infancy. Lancet. 2020 Feb 19. [QxMD MEDLINE Link].

28. Chamlin SL, Kao J, Frieden IJ, et al. Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: changes in barrier function provide a sensitive indicator of disease activity. J Am Acad Dermatol. 2002 Aug. 47(2):198-208. [QxMD MEDLINE Link].

29. Zirwas MJ, Barkovic S. Anti-Pruritic Efficacy of Itch Relief Lotion and Cream in Patients With Atopic History: Comparison With Hydrocortisone Cream. J Drugs Dermatol. 2017 Mar 1. 16 (3):243-247. [QxMD MEDLINE Link].

30. Leloup P, Stalder JF, Barbarot S. Outpatient Home-based Wet Wrap Dressings with Topical Steroids with Children with Severe Recalcitrant Atopic Dermatitis: A Feasibility Pilot Study. Pediatr Dermatol. 2015 Apr 22. [QxMD MEDLINE Link].

31. Paller AS, Tom WL, Lebwohl MG, Blumenthal RL, Boguniewicz M, Call RS, et al. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016 Sep. 75 (3):494-503.e4. [QxMD MEDLINE Link]. [Full Text].

32. Eucrisa (crisaborole) [package insert]. Collegeville, Pa: Anacor Pharmaceuticals, Inc. March 2020. Available at [Full Text].

33. Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, et al. Dupilumab treatment in adults with moderate-to-severe atopic dermatitis. N Engl J Med. 2014 Jul 10. 371 (2):130-9. [QxMD MEDLINE Link].

34. Thaçi D, Simpson EL, Beck LA, Bieber T, Blauvelt A, Papp K, et al. Efficacy and safety of dupilumab in adults with moderate-to-severe atopic dermatitis inadequately controlled by topical treatments: a randomised, placebo-controlled, dose-ranging phase 2b trial. Lancet. 2016 Jan 2. 387 (10013):40-52. [QxMD MEDLINE Link].

35. Simpson EL, Bieber T, Guttman-Yassky E, Beck LA, Blauvelt A, Cork MJ, et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. N Engl J Med. 2016 Dec 15. 375 (24):2335-2348. [QxMD MEDLINE Link].

36. Frellick M. Dupilumab Effective in Teens With Moderate to Severe Eczema. Medscape Medical News. Available at https://www.medscape.com/viewarticle/902207. September 19, 2018; Accessed: April 2, 2020.

37. Paller AS, Siegfried E, Gooderham M, Beck LA, Boguniewica M, Sher L, et al. Dupilumab significantly improves atopic dermatitis in children aged 6 to 12 years: Results from phase 3 trial (LIBERTY AD PEDS) (abstract 215). Presented at Revolutionizing Atopic Dermatitis 2020 virtual meeting. April 5, 2020. [Full Text].

38. Schwartz DM, Bonelli M, Gadina M, O'Shea JJ. Type I/II cytokines, JAKs, and new strategies for treating autoimmune diseases. Nat Rev Rheumatol. 2016 Jan. 12 (1):25-36. [QxMD MEDLINE Link]. [Full Text].

39. Oetjen LK, Mack MR, Feng J, Whelan TM, Niu H, Guo CJ, et al. Sensory Neurons Co-opt Classical Immune Signaling Pathways to Mediate Chronic Itch. Cell. 2017 Sep 21. 171 (1):217-228.e13. [QxMD MEDLINE Link]. [Full Text].

40. Papp K, Szepietowski JC, Kircik L, Toth D, Eichenfield LF, Leung DYM, et al. Efficacy and safety of ruxolitinib cream for the treatment of atopic dermatitis: Results from 2 phase 3, randomized, double-blind studies. J Am Acad Dermatol. 2021 Oct. 85 (4):863-872. [QxMD MEDLINE Link]. [Full Text].

41. Guttman-Yassky E, et al. Once-daily upadacitinib versus placebo in adolescents and adults with moderate-to-severe atopic dermatitis (Measure Up 1 and Measure Up 2): results from two replicate double-blind, randomised controlled phase 3 trials. Lancet. 2021 Jun 5. 397 (10290):2151-2168. [QxMD MEDLINE Link].

42. Reich K, Teixeira HD, de Bruin-Weller M, Bieber T, Soong W, Kabashima K, et al. Safety and efficacy of upadacitinib in combination with topical corticosteroids in adolescents and adults with moderate-to-severe atopic dermatitis (AD Up): results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2021 Jun 5. 397 (10290):2169-2181. [QxMD MEDLINE Link].

43. Novak N. Allergen specific immunotherapy for atopic dermatitis. Curr Opin Allergy Clin Immunol. 2007 Dec. 7(6):542-46. [QxMD MEDLINE Link].

44. Huang C, Tang J. Sublingual immunotherapy with Dermatophagoides farinae drops for pediatric atopic dermatitis. Int J Dermatol. 2022 Feb. 61 (2):246-251. [QxMD MEDLINE Link].

45. [Guideline] Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008 Jan. 121(1):183-91. [QxMD MEDLINE Link].

46. Yang YW, Tsai CL, Lu CY. Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies. Br J Dermatol. 2009 Aug. 161(2):373-83. [QxMD MEDLINE Link].

47. Miyake Y, Tanaka K, Sasaki S, et al. Breastfeeding and atopic eczema in Japanese infants: The Osaka Maternal and Child Health Study. Pediatric Allergy & Immunology. May 2009. 20:234-241. [QxMD MEDLINE Link].

48. Jin YY, Cao RM, Chen J, Kaku Y, Wu J, Cheng Y, et al. Partially hydrolyzed cow's milk formula has a therapeutic effect on the infants with mild to moderate atopic dermatitis: a randomized, double-blind study. Pediatr Allergy Immunol. 2011 May 4. [QxMD MEDLINE Link].

49. Arellano FM, Arana A, Wentworth CE, et al. Lymphoma among patients with atopic dermatitis and/or treated with topical immunosuppressants in the United Kingdom. J Allergy Clin Immunol. 2009 May. 123(5):1111-6, 116.e1-13. [QxMD MEDLINE Link].

50. Chang YS, Chou YT, Lee JH, Lee PL, Dai YS, Sun C, et al. Atopic dermatitis, melatonin, and sleep disturbance. Pediatrics. 2014 Aug. 134(2):e397-405. [QxMD MEDLINE Link].

51. Xerfan EMS, Tomimori J, Andersen ML, Tufik S, Facina AS. Sleep disturbance and atopic dermatitis: A bidirectional relationship?. Med Hypotheses. 2020 Feb 18. 140:109637. [QxMD MEDLINE Link].

52. Capozza K, Gadd H, Kelley K, Russell S, Shi V, Schwartz A. Insights From Caregivers on the Impact of Pediatric Atopic Dermatitis on Families: "I'm Tired, Overwhelmed, and Feel Like I'm Failing as a Mother". Dermatitis. 2020 Feb 21. [QxMD MEDLINE Link].

53. Boguniewicz M. Topical treatment of atopic dermatitis. Immunol Allergy Clin North Am. 2004 Nov. 24(4):631-44, vi-vii. [QxMD MEDLINE Link].

54. Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol. 2008 Jan. 121(1):116-121.e11. [QxMD MEDLINE Link].

55. Epstein TG, Bernstein DI, Levin L, Khurana Hershey GK, Ryan PH, Reponen T, et al. Opposing effects of cat and dog ownership and allergic sensitization on eczema in an atopic birth cohort. J Pediatr. 2011 Feb. 158(2):265-71.e1-5. [QxMD MEDLINE Link].

56. Thyssen JP, Godoy-Gijon E, Elias PM. Ichthyosis vulgaris - the filaggrin mutation disease. Br J Dermatol. 2013 Jan 10. [QxMD MEDLINE Link].

57. Blattner CM, Murase JE. A practice gap in pediatric dermatology: does breast-feeding prevent the development of infantile atopic dermatitis?. J Am Acad Dermatol. 2014 Aug. 71(2):405-6. [QxMD MEDLINE Link].

58. Thyssen JP, Vestergaard C, Barbarot S, et al. European Task Force on Atopic Dermatitis: position on vaccination of adult patients with atopic dermatitis against COVID-19 (SARS-CoV-2) being treated with systemic medication and biologics. J Eur Acad Dermatol Venereol. 2021 Feb 15. [QxMD MEDLINE Link].

59. Broeders JA, Ahmed Ali U, Fischer G. Systematic review and meta-analysis of randomized clinical trials (RCTs) comparing topical calcineurin inhibitors with topical corticosteroids for atopic dermatitis: A 15-year experience. J Am Acad Dermatol. 2016 May 11. [QxMD MEDLINE Link].

60. Tiplica GS, Boralevi F, Konno P, Malinauskiene L, Kaszuba A, Laurens C, et al. The regular use of an emollient improves symptoms of atopic dermatitis in children: a randomized controlled study. J Eur Acad Dermatol Venereol. 2018 Feb 8. [QxMD MEDLINE Link].

61. Janmohamed SR, Oranje AP, Devillers AC, Rizopoulos D, van Praag MC, Van Gysel D, et al. The proactive wet-wrap method with diluted corticosteroids versus emollients in children with atopic dermatitis: a prospective, randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 2014 Jun. 70(6):1076-82. [QxMD MEDLINE Link].

62. Draelos ZD, Stein Gold LF, Murrell DF, Hughes MH, Zane LT. Post Hoc Analyses of the Effect of Crisaborole Topical Ointment, 2% on Atopic Dermatitis: Associated Pruritus from Phase 1 and 2 Clinical Studies. J Drugs Dermatol. 2016 Feb 1. 15 (2):172-6. [QxMD MEDLINE Link].

63. Saeki H, Baba N, Ito K, Yokota D, Tsubouchi H. Difamilast, a selective phosphodiesterase 4 inhibitor, ointment in paediatric patients with atopic dermatitis: a phase III randomized double-blind, vehicle-controlled trial. Br J Dermatol. 2022 Jan. 186 (1):40-49. [QxMD MEDLINE Link]. [Full Text].

64. Paghdal KV, Schwartz RA. Topical tar: back to the future. J Am Acad Dermatol. 2009 Aug. 61(2):294-302. [QxMD MEDLINE Link].

65. Luger T, Boguniewicz M, Carr W, et al. Pimecrolimus in atopic dermatitis: Consensus on safety and the need to allow use in infants. Pediatr Allergy Immunol. 2015 Jun. 26 (4):306-15. [QxMD MEDLINE Link].

66. Leung DY, Hanifin JM, Pariser DM, et al. Effects of pimecrolimus cream 1% in the treatment of patients with atopic dermatitis who demonstrate a clinical insensitivity to topical corticosteroids: a randomized, multicentre vehicle-controlled trial. Br J Dermatol. 2009 Aug. 161(2):435-43. [QxMD MEDLINE Link].

67. Doss N, Reitamo S, Dubertret L, et al. Superiority of tacrolimus 0.1% ointment compared with fluticasone 0.005% in adults with moderate to severe atopic dermatitis of the face: results from a randomized, double-blind trial. Br J Dermatol. 2009 Aug. 161(2):427-34. [QxMD MEDLINE Link].

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69. Jensen JM, Pfeiffer S, Witt M, et al. Different effects of pimecrolimus and betamethasone on the skin barrier in patients with atopic dermatitis. J Allergy Clin Immunol. 2009 May. 123(5):1124-33. [QxMD MEDLINE Link].

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73. Ferreira S, Torres T. Dupilumab for the Treatment of Atopic Dermatitis. Actas Dermosifiliogr. 2018 Feb 5. [QxMD MEDLINE Link].

74. Simon D, Hosli S, Kostylina G, Yawalkar N, Simon HU. Anti-CD20 (rituximab) treatment improves atopic eczema. J Allergy Clin Immunol. 2008 Jan. 121(1):122-8. [QxMD MEDLINE Link].

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76. Deo M, Yung A, Hill S, Rademaker M. Methotrexate for treatment of atopic dermatitis in children and adolescents. Int J Dermatol. 2014 Aug. 53(8):1037-41. [QxMD MEDLINE Link].

77. Bieber T. Atopic dermatitis: an expanding therapeutic pipeline for a complex disease. Nat Rev Drug Discov. 2022 Jan. 21 (1):21-40. [QxMD MEDLINE Link]. [Full Text].

78. Simpson EL, Flohr C, Eichenfield LF, Bieber T, Sofen H, Taïeb A, et al. Efficacy and safety of lebrikizumab (an anti-IL-13 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by topical corticosteroids: A randomized, placebo-controlled phase II trial (TREBLE). J Am Acad Dermatol. 2018 Jan 15. [QxMD MEDLINE Link].

79. Guttman-Yassky E, Silverberg JI, Nemoto O, Forman SB, Wilke A, Prescilla R, et al. Baricitinib in adult patients with moderate-to-severe atopic dermatitis: a phase 2 parallel, double-blinded, randomized placebo-controlled multiple-dose study. J Am Acad Dermatol. 2018 Feb 1. [QxMD MEDLINE Link].

80. Simpson EL, Sinclair R, Forman S, Wollenberg A, Aschoff R, Cork M, et al. Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet. 2020 Jul 25. 396 (10246):255-266. [QxMD MEDLINE Link]. [Full Text].

81. Eichenfield LF, Flohr C, Sidbury R, Siegfried E, Szalai Z, Galus R, et al. Efficacy and Safety of Abrocitinib in Combination With Topical Therapy in Adolescents With Moderate-to-Severe Atopic Dermatitis: The JADE TEEN Randomized Clinical Trial. JAMA Dermatol. 2021 Oct 1. 157 (10):1165-1173. [QxMD MEDLINE Link]. [Full Text].

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Osteopathic Association

Disclosure: Nothing to disclose.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Caroline C Spagnola, MD, to the development and writing of this article.

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