Atopic Dermatitis (AD) Across Ages: Identifying and Treating Flares in Children and Adults
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.
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
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