Now Playing
Opinion|Videos|April 2, 2025
Atopic Dermatitis (AD) Across Ages: Identifying and Treating Flares in Children and Adults
Author(s)Lisa Swanson, MD
A panelist discusses how healthcare providers can effectively identify and manage atopic dermatitis flares across different age groups, highlighting the unique challenges and treatment approaches for both pediatric and adult populations.
Advertisement
Atopic Dermatitis (AD) Across Ages: Identifying and Treating Flares in Children and Adults
Clinical Presentation
- AD manifests differently across age groups: infantile (2-24 months), childhood (2-12 years), adolescent/adult (>12 years)
- Key features: intense pruritus, erythema, exudation, scaling, lichenification
- Distribution patterns vary by age: face/trunk in infants, flexural areas in children, hands/neck/eyelids in adults
Flare Identification
- Characterized by acute worsening of pruritus, erythema, vesiculation with weeping/oozing
- Common triggers: irritants, allergens, stress, infections, climate changes
- Early identification critical for prompt intervention
Treatment Strategies
First-Line Therapy: Optimize skin hydration, repair barrier function
- Regular emollient use (ceramide-containing preferred)
- Gentle cleansers, lukewarm water, immediate moisturization after bathing
Anti-inflammatory Treatments:
- Topical corticosteroids (TCS): Choose potency based on severity, location, patient age
- Topical calcineurin inhibitors (TCIs): Steroid-sparing, suitable for sensitive areas
- Phosphodiesterase-4 inhibitors: Newer options with favorable safety profiles
Severe/Recalcitrant Cases:
- Phototherapy (narrowband UVB, UVA1)
- Systemic immunosuppressants (cyclosporine, methotrexate, azathioprine)
- Biologics (dupilumab, tralokinumab) for moderate-to-severe disease
Age-Specific Considerations
Pediatric Patients:
- Lower potency TCS, careful monitoring for systemic absorption
- Special attention to infection risk, particularly eczema herpeticum
- Educational support for parents/caregivers on proper application techniques
Adult Patients:
- Extended maintenance therapy often required
- Occupational considerations (hand dermatitis)
- Comorbidity management (anxiety, depression, sleep disturbance)
Preventive Strategies
- Trigger avoidance: customized plans based on identified triggers
- Proactive therapy: intermittent use of anti-inflammatories on previously affected sites
- Patient education: comprehensive self-management, recognizing early signs of flares
Follow-up Care
- Regular assessment of disease control, treatment adherence
- Adjustment of treatment regimens based on response
- Multidisciplinary approach for cases with significant psychosocial impact
Advertisement
Related to this article
Evolocumab was associated with a 20% lower risk of fatal or nonfatal myocardial infarction than ezetimibe among more than 544 000 adults with ASCVD.
The FDA cleared Access MeMed BV, a host-response blood test that helps distinguish bacterial from viral infections in adults and children in as little as 15 minutes.
Greater Mediterranean diet adherence was associated with lower odds of adult acne, particularly among women, in a UK Biobank study of dietary patterns.
Abbott's investigational device achieved 96.3% complete left atrial appendage closure by echocardiography, with a 1.8% ischemic stroke rate at 1 year.
October FDA news included updates on long-acting olanzapine, multi-cancer blood testing, stroke rehabilitation, and heart failure monitoring.
Christoph Correll, MD, discusses the new once-monthly olanzapine injection for schizophrenia, including clinical efficacy, metabolic risks, and patient selection.
Cheryl Cox Kinney, MD, explains when night sweats warrant further evaluation, including red flags, persistent symptoms, and potential nonmenopausal causes.
TMS 2026: Menopause was coded in just 7.8% of midlife outpatient visits. Arina Chesnokova, MD, MPH, discusses diagnosis gaps, prescribing risks, and solutions for primary care.
Advertisement
Advertisement