Consensus conference on pediatric atopic dermatitis

doi:10.1016/S0190-9622(03)02539-8

Journal of the American Academy of Dermatology

Volume 49, Issue 6, December 2003, Pages 1088-1095

https://doi.org/10.1016/S0190-9622(03)02539-8 Get rights and content

Section snippets

Section i: epidemiology of ad

I.
Are there adequate, reliable, pathogenetic, and other defining features of atopic dermatitis (AD)?
AD is best viewed as a syndrome. Clinical findings that define this syndrome and clinical criteria of AD include the following:
- A.
  Essential features (must be present)
  - 1.
    Pruritus
  - 2.
    Eczema (acute, subacute, chronic)
    a.
    Typical morphology and age-specific patterns *

Section ii. pathogenesis of atopic dermatitis

I.
What are the immunologic, biochemical, and other pathogenic mechanisms of AD?
The pathogenesis of AD is a complex interplay of numerous elements including immune, genetic, metabolic, infectious, and neuroendocrine factors, and their interaction with the environment. Even an introductory discussion of this topic is beyond the scope of this article. Factors that are considered the most important or newer concepts that have the potential to be important contributors to the understanding of

Section iii: atopy, allergen exposure, and atopic dermatitis development

I.
What is the influence of maternal food intake and early infant feeding patterns on AD development?
The influence of maternal food intake and infant feeding patterns on AD development is a complex issue. Food allergies are more common in children with established AD than in nonatopic children, and IgE-mediated sensitization is demonstrable in the majority of, but not all, AD patients by a variety of methods including skin prick tests, specific IgE antibodies and allergen patch tests. Prospective

Section iv: treatment

I.
What is the evidence basis for standard treatments of AD, including topical corticosteroids, systemic corticosteroids, systemic antihistamines, allergen avoidance, and bathing regimens? How safe are topical corticosteroids when used over a long period?
The evidence supporting the efficacy and safety of standard treatments of AD varies greatly. A useful summary has been compiled by the Cochraine group (Hoare C, LiWan Po A, Williams H. Health Technol Assess 2000;4:1-191; available at //www.ncchata.org/htapubs.htm

Acknowledgements

The following individuals participated in the Consensus Conference on Pediatric Atopic Dermatitis: Lawrence F. Eichenfield, MD, Chair; Vincent S. Beltrani, MD; James Bergman, MD; Kenneth E. Bloom, MD; Mark Boguniewicz, MD; Sarah Lynn Chamlin, MD; Richard A. Clark, MD; Bernard Cohen, MD; Mark Dahl, MD; Roselyn E. Epps, MD; Nancy Burton Esterly, MD; Shelia Fallon-Friedlander, MD; Ilona J. Frieden, MD; Jon M. Hanifin, MD; Adelaide A. Herbert, MD; Paul J. Honig, MD; Bernice R. Krafchik, MD; Daniel

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Cited by (240)

Genome-Wide Integration of Genetic and Genomic Studies of Atopic Dermatitis: Insights into Genetic Architecture and Pathogenesis
2022, Journal of Investigative Dermatology
Atopic dermatitis (AD) is a common heterogeneous, chronic, itching, and inflammatory skin disease. Genetic studies have identified multiple AD susceptibility genes. However, the genetic architecture of AD has not been elucidated. In this study, we conducted a large-scale meta-analysis of AD (35,647 cases and 1,013,885 controls) to characterize the genetic basis of AD. The heritability of AD in different datasets varied from 0.6 to 7.1%. We identified 31 previously unreported genes by integrating multiomics data. Among the 31 genes, MCL1 was identified as a potential treatment target for AD by mediating gene‒drug interactions. Tissue enrichment analyses and phenome-wide association study provided strong support for the role of the hemic and immune systems in AD. Across 1,207 complex traits and diseases, genetic correlations indicated that AD shared links with multiple respiratory phenotypes. The phenome-wide Mendelian randomization analysis (Mendelian randomization‒phenome-wide association study) revealed that the age of onset of diabetes exhibited a positive causal effect on AD (inverse-variance weighted β = 0.39, SEM = 0.09, P = 2.77 × 10⁻⁵). Overall, these results provide important insights into the genetic architecture of AD and will lead to a more thorough and complete understanding of the molecular mechanisms underlying AD.
Sensitizing agents found in children and adolescents with recalcitrant atopic dermatitis: a cross-sectional study with a pediatric battery
2022, Anais Brasileiros de Dermatologia
Atopic dermatitis is the most common inflammatory skin disease in childhood and has an important impact on quality of life, especially severe cases or those that are recalcitrant to treatments. Sensitization to allergens with the potential for allergic contact dermatitis is a factor associated with cases of recalcitrant atopic dermatitis. Understanding the relationship between atopic dermatitis, allergens, and allergic contact dermatitis is essential. In Brazil, there are no studies on sensitization to allergens found in patch tests with pediatric batteries in patients with atopic dermatitis.
To verify the main sensitizing agents, the prevalence of allergic contact dermatitis and the epidemiological and clinical profile of children and adolescents with atopic dermatitis.
Cross-sectional, prospective study in patients between 4 and 18 years of age, with recalcitrant atopic dermatitis, treated at the Sanitary Dermatology Outpatient Clinic (RS). All patients underwent patch tests with a battery of pediatric allergens.
The prevalence of sensitization and allergic contact dermatitis in the evaluated patients was 37.07% (20/54) and 27.7% (15/54), respectively. The most frequent allergens were: nickel sulfate (16.7%), disperse blue (5.6%), and fragrance mix I (5.6%). Nickel was associated with the female sex (p = 0.019).
Sample size and selection, absence of a control group.
A proportion of patients with recalcitrant atopic dermatitis may be sensitized to different allergens and may even have developed allergic contact dermatitis. Recognizing this context is important in the prevention strategy and management of the disease.
Generation and Validation of the Patient-Reported Outcome Measurement Information System Itch Questionnaire–Child (PIQ-C) to Measure the Impact of Itch on Life Quality
2022, Journal of Investigative Dermatology
Itch compromises QOL, but most itch assessments focus only on itch intensity. We aimed to develop and validate a comprehensive Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric measure for itch symptoms and itch impact, defined as the effect specifically of itch on physical, mental, and social health, all of which can affect life quality. After literature review, concept elicitation and cognitive interviews with parents and children with itch, and repeated content-expert review, an item pool was generated and refined. The pool was calibrated with data from 499 children with pruritus using exploratory and confirmatory factor analyses, item response theory, and item fit analysis. The resultant 45-item bank, PROMIS Itch Questionnaire–Child (PIQ-C), showed good convergent and discriminant validity in 181 children aged 8‒17 years, discriminating children with different levels of severity, and was responsive to change. Strong correlations (rho ≥ 0.60) were observed with pain and sleep measures, and moderate correlations were observed with other pediatric Patient-Reported Outcomes Measurement Information System measures. Patient-Reported Outcomes Measurement Information System Itch Questionnaire–Child comprehensively measures itch intensity and burden, providing an itch-specific alternative for assessing life quality. The independent calibration of each item/question allows for flexibility in generating short forms or computerized adaptive testing for efficient use in research and office practice.
Emerging Systemic Therapeutic Biologics and Small Molecules for Atopic Dermatitis: How to Decide Which Treatment Is Right for Your Patients
2021, Journal of Allergy and Clinical Immunology: In Practice
The evolving discoveries in atopic dermatitis (AD) broaden our understanding of the pathogenesis of the disease and, above all, enable better management for patients. Dupilumab was the first biologic for AD, and since its approval, many new treatments have emerged in both late- and early-stage clinical trials. These trials have led to a further understanding of the pathogenesis of AD and to the identification of additional potential therapeutic targets. This review will highlight the emerging therapies and provide approaches on how to choose the right treatment for your patients.
Evaluation of primary care practices in management of adult atopic dermatitis
2021, Revue Francaise d'Allergologie
Une majorité des adultes consultant pour une dermatite atopique (DA) présente une forme modérée à sévère, alors qu’existent des consensus d’experts et de traitements efficaces. L’objectif de cette enquête était d’évaluer les pratiques en soins primaires pour la prise en charge diagnostique et thérapeutique de la DA de l’adulte.
Une enquête de pratique a été réalisée à l’aide d’un questionnaire en ligne auprès de 2307 médecins généralistes (MG) français de janvier à mars 2019.
Les réponses de 200 MG ont été analysées. Parmi eux, 63 % (n = 126) exprimaient des difficultés dans la prise en charge de la DA. Le diagnostic de DA était facile pour 50 % (n = 101) des MG, avec une excellente connaissance des critères diagnostiques de la DA. La prise en charge thérapeutique comprenait les émollients en traitement de fond et les dermocorticoïdes (DC) pour les poussées pour 99 % (n = 198) des MG. Cependant, la prescription de DC était : (i) réservée aux lésions sévères dans 50 % des cas, (ii) de durée variable entre les MG, (iii) mal quantifiée, avec une méconnaissance de l’unité phalangette par 78 % des MG. L’inobservance aux DC était rapportée comme étant la principale cause d’échec thérapeutique dans 79 % des cas, alors même que les conseils d’utilisation des DC semblaient discordants ou insuffisants.
Malgré une bonne connaissance théorique, des améliorations sont nécessaires dans la prise en charge pratique de la DA en soins primaires. Le développement de fiches d’information pourrait améliorer cette prise en charge.
Most of adults with atopic dermatitis (AD) who consult for a moderate to a severe type of AD whereas there are existing established experts consensus and efficient treatments. This survey's aim was to assess primary care practices in diagnostic and therapeutic management of adult AD.
An survey focused on medical practice was withdrawn to 2307 French general practitioners (GP) using an online questionnaire from January to March 2019.
200 GPs answers were analyzed. Among them, 63% (n = 126) pointed out difficulties in adult AD management. AD diagnosis appeared easy for 50% (n = 101), with excellent knowledge of AD diagnostic criteria. Therapeutic management included emollients as a background treatment and topical corticosteroids (TCS) in case of flare-up for 99% (n = 198) of GPs. However, TCS prescription was : (i) dedicated to severe lesions in 50% of cases, (ii) various in terms of treatment duration between GPs, (iii) not well measured out, especially as 78% of GP didn’t know the FingerTip Unit (FTU). Low compliance to TCS treatment was pointed out as the main cause of therapeutic failure in 79% of cases, whereas TCS use advices seemed discordant or insufficient.
Despite good theorical knowledge, more progress could still be done in primary care of practical AD management. The development of information sheets could improve this management.
Efficacy and safety of dupilumab with concomitant topical corticosteroids in children 6 to 11 years old with severe atopic dermatitis: A randomized, double-blinded, placebo-controlled phase 3 trial
2020, Journal of the American Academy of Dermatology
Citation Excerpt :
The study design included screening up to 9 weeks, TCS standardization for 2 weeks, treatment for 16 weeks, and follow-up for 12 weeks (only for those patients who declined or were ineligible to participate in a subsequent open-label extension study, NCT02612454). Key inclusion criteria were children age 6-11 years with AD (American Academy of Dermatology consensus criteria20) diagnosed ≥1 year before screening; Investigator's Global Assessment (IGA) score of 4, Eczema Area and Severity Index (EASI) score ≥21, affected BSA ≥15%, weekly averaged baseline worst itch score (Peak Pruritus Numerical Rating Scale [NRS]) ≥4; weight ≥15 kg; and documented history of inadequate response to topical AD medication within 6 months of baseline. Patients were randomized 1:1:1 to dupilumab + TCS every 2 weeks (q2w + TCS; weight-tiered: baseline weight 15 to <30 kg, 100 mg q2w + TCS, 200 mg loading dose; baseline weight ≥30 kg, 200 mg q2w + TCS, 400 mg loading dose); dupilumab + TCS every 4 weeks (300 mg q4w + TCS; 600 mg loading dose regardless of weight); or matching placebo + TCS.
Children with severe atopic dermatitis (AD) have limited treatment options.
We report the efficacy and safety of dupilumab + topical corticosteroids (TCS) in children aged 6-11 years with severe AD inadequately controlled with topical therapies.
In this double-blind, 16-week, phase 3 trial (NCT03345914), 367 patients were randomized 1:1:1 to 300 mg dupilumab every 4 weeks (300 mg q4w), a weight-based regimen of dupilumab every 2 weeks (100 mg q2w, baseline weight <30 kg; 200 mg q2w, baseline weight ≥30 kg), or placebo; with concomitant medium-potency TCS.
Both the q4w and q2w dupilumab + TCS regimens resulted in clinically meaningful and statistically significant improvement in signs, symptoms, and quality of life (QOL) versus placebo + TCS in all prespecified endpoints. For q4w, q2w, and placebo, 32.8%, 29.5%, and 11.4% of patients, respectively, achieved Investigator's Global Assessment scores of 0 or 1; 69.7%, 67.2%, and 26.8% achieved ≥75% improvement in Eczema Area and Severity Index scores; and 50.8%, 58.3%, and 12.3% achieved ≥4-point reduction in worst itch score. Response to therapy was weight-dependent: optimal dupilumab doses for efficacy and safety were 300 mg q4w in children <30 kg and 200 mg q2w in children ≥30 kg. Conjunctivitis and injection-site reactions were more common with dupilumab + TCS than with placebo + TCS.
Short-term 16-week treatment period; severe AD only.
Dupilumab + TCS is efficacious and well tolerated in children with severe AD, significantly improving signs, symptoms, and QOL.

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J Am Acad Dermatol 2003;49:1088-95.

Published online October 1, 2003.

^*: A list of participants in the Consensus Conference on Pediatric Atopic Dermatitis may be found at the end of this article.

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From the AcademyConsensus conference on pediatric atopic dermatitis* ☆,